1. Awareness, treatment, and control rates of hypertension in England improved over the past 17 years while overall prevalence had remained stable.
2. Nearly 50,000 major cardiovascular events would be prevented if the same trends in hypertension management and control were to continue between now and 2022.
Evidence Rating Level: 2 (Good)
Study Rundown: Hypertension is the most important risk factor when observing global mortality. High blood pressure has a critical impact on the risk for major cardiovascular events such as stroke and myocardial infarction. Prevention of events such as these with adequate control of hypertension not only spares patients long term morbidity but has also proven to be more cost effective than acute management of cardiovascular events. The authors of this study utilized data from five Health Survey for England surveys to obtain a cross sectional analysis of the prevalence and management patterns of hypertension between the years of 1994 and 2011. The investigators observed that there had been an overall improvement in the awareness, treatment, and control rates of hypertension in England between 1994 and 2011. Nevertheless, the control rate remained low at 37%. This study provided an excellent snapshot of the current trends in hypertensive prevalence and management in England due to the large nation-wide and randomly selected sample included in the study. A potential limitation was that only 53% of the original set of patients interviewed received a nurse visit and had valid blood pressure readings taken.
Relevant Reading: Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study
In-Depth [serial cross-sectional study]: This study included 4540 individuals 16 years old or greater. Participants underwent an at home interview followed by a nurse visit to obtain blood pressure measurements.
The mean blood pressures were 128.9 (standard error, SE 0.37)/73.1 (SE 0.3) mm Hg in men and 122.1 (SE 0.44)/72.0 (SE 0.28) mm Hg in women. 30% (SE 0.8) of participants were found to be hypertensive as defined as having a systolic blood pressure of 140 mm Hg or greater, or a diastolic blood pressure of 90 mmHg or greater, the prevalence was slightly higher in men (32%, SE 1.1) than in women (28%, SE 1.0). Control rates among all participants with hypertension increased from 11% in 1994 to 37% in 2011, along with a drop in the proportion of adults with untreated hypertension from 21% to 13% in the same time period. The authors estimated that if the 1994 English population had been exposed to the improved treatment rates and blood pressure control achieved by 2011, between 68,000 and 100,000 vascular events could have been avoided.
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