Significant advances in hypertension management prevent major cardiovascular events

Hypertension (raised blood pressure) treatment rates have almost doubled and control rates have trebled in England between 1994 and 2011, resulting in the saving of tens of thousands of lives each year, according to a new study published in a special themed issue of The Lancet. The issue is published ahead of ahead of Hypertension 2014, the Joint Meeting of the European Society of Hypertension (ESH) and International Society of Hypertension (ISH), to be held in Athens, Greece, June 13-16, 2014.

The findings also suggest that if these improvements in blood pressure management continue until 2022, 80% of patients being treated for hypertension will have achieved control of their high blood pressure, preventing a further 50 000 major cardiovascular events (eg, strokes, heart attacks, and deaths) in that year.

“Although the rates of diagnosis, treatment, and control of raised blood pressure remain suboptimum in England, our findings are still a cause for optimism”, explains study leader Emanuela Falaschetti from Imperial College London in the UK.  

“Whereas once the ‘rule of halves’ prevailed—half the general population with high blood pressure were diagnosed, half of those detected treated, and half of those treated controlled—now management in England is better than the rule of two-thirds. As a result of these improvements in practice, several hundreds of thousands of major cardiovascular events might have been prevented.”

Hypertension (blood pressure 140/90mm Hg or higher) is the single most important risk factor for early death, causing an estimated 9.4 million deaths every year worldwide. Around 30% of people in England have high blood pressure.

Using data from five Health Survey for England surveys (1994, 1998, 2003, 2006, and 2011)—nationally representative samples of adults aged 16 years and older living in private households—the researchers analysed trends in the awareness, treatment, and control of raised blood pressure during the past 17 years.

Encouragingly, the results showed that average blood pressure levels of men and women in the general population have steadily improved between 1994 and 2011, with average systolic blood pressure falling by about 5mm Hg in men and 9mm Hg in women.

Additionally, treatment rates have almost doubled between 1994 and 2011, with 58% of hypertensive adults receiving treatment in 2011. Among those treated, patients keeping their blood pressure under control (<140/90mm Hg) have almost doubled from 33% in 1994 to 63% in 2011. As a result, in adults receiving treatment, blood pressure levels have fallen 15mm Hg since 1994.

Richard McManus from the University of Oxford in the UK and Jonathan Mant from the University of Cambridge in the UK, authors of a linked Comment say, “Many public health initiatives aim to reduce the population burden of hypertension and along with physicians in primary care—who provide most hypertension management in the UK—have led to substantial advances in hypertension management and blood pressure control. Falaschetti and colleagues’ study provides a welcome example of the combined effects of individual physicians and policy makers on a simple but important risk factor. After 50 years of treatment, it seems that the drugs are working!”