Just one in three US patients has control of BP and cholesterol

Charleston, SC - Less than one in three patients in the US have their blood-pressure and cholesterol levels under control, according to a new analysis of the National Health and Nutrition Examination Surveys (NHANES) [1]. Researchers say there exist significant opportunities for reaching national coronary heart disease prevention goals by improving hypertension and cholesterol control.

"It"s been known for many years that people with high blood pressure have about double the risk of coronary heart disease, but treating hypertension with the usual ways we go about it reduces heart attack risk by about 25%," lead investigator Dr Brent Egan (Medical University of South Carolina, Charleston) told heartwire. "So that leaves a lot of residual risk. While it"s been known that treating multiple risk factors is more beneficial than treating any one risk factor alone, I think it might be underappreciated in terms of how important it is to treat and control both high blood pressure and cholesterol."

In the study, published online July 1, 2013 in Circulation, the researchers assessed concurrent hypertension and hypercholesterolemia control in NHANES 1988 to 1994, 1999 to 2004, and 2005 to 2010. Across the three surveys, 60.7% to 64.3% of the individuals with hypertension also had high cholesterol levels. The control of LDL-cholesterol levels increased over time, up from 9.2% in 1988-1994 to 45.4% in 2005-2010. In 2005-2010, approximately 54% of all hypertensive patients had good blood-pressure control, defined as <140/90 mm Hg. In total, 44.5% of all hypertensive patients were treated and controlled and 21.5% were treated and uncontrolled. 

Healthy blood vessels are essential for a good quality of life. 

For patients with high blood pressure and elevated cholesterol levels, the concomitant control of both risk factors increased approximately sixfold from 1988-1994 to 2005-2010. The control of blood pressure and LDL-cholesterol levels increased from 5.0% in 1988-1994 to 30.7% in 2005-2010. The concomitant control of blood pressure, LDL cholesterol, and non-HDL cholesterol levels increased from 1.8% in 1988-1994 to 26.9% in 2005-2010. When more stringent blood-pressure targets were applied for patients with chronic kidney disease or diabetes, even fewer patients had concomitant control of blood pressure and hypercholesterolemia. 

"What we find is that while there has been a lot of progress in controlling both blood pressure and cholesterol, still about 70% of patients who have high blood pressure and high cholesterol don"t have both risk factors controlled," said Egan. 

Getting into the healthcare system

To heartwire, Egan said the majority of patients with uncontrolled blood pressure and cholesterol are untreated. Many of these untreated individuals are unaware of their risk factors and they are infrequently seen by a primary-care physician. In their analysis, patients who visited with a physician two or more times per year were two times more likely to have both risk factors controlled. For patients treated with a statin, these patients were 10 times more likely to have both risk factors controlled, while those taking antihypertensive medications were three times more likely to have both blood-pressure and cholesterol levels at target. 

"Nationally, with the Affordable Care Act and other efforts, there has been more of push to get more patients into the healthcare system, but we know that even a fair number of people who already have insurance, particularly men under the age of 50 or 55 years, often use primary care sparingly," said Egan. "When people are seen infrequently or not at all, they"re less likely to have these risk factors detected and treated. And when they are treated, they are less likely to have the medications intensified."

Therapeutic inertia, which occurs when a patient is treated but the therapy is not intensified when the patient fails to get to goal, remains a significant problem, added Egan. From the patient side of things, there can be an aspect of fatalism when it comes to heart attacks and strokes, but the benefits of treating high blood pressure and elevated cholesterol extend beyond coronary heart disease.

"Healthy blood vessels are essential for a good quality of life," Egan told heartwire. "Dementia, for example, is driven by these risk factors. And just in general, our health, endurance, and sharpness of mind are much better if we have healthy blood vessels. Hypertension and high cholesterol are things that damage these vessels and cause us to lose that quality of life earlier than is necessary."

For the past 15 years, Egan and other colleagues have been working in South Carolina to reduce mortality from heart disease and stroke. During this time, they have made significant progress. "In South Carolina, we"ve actually gone from 50th to 34th nationally, more progress than in any of the other stroke-belt states, in terms of reducing our ranking in cardiovascular mortality," he said. "But there"s a lot more to be done."

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