Background Treatment of hypertension is one of the most commonclinical responsibilities of U.S. physicians, yet only one fourthof patients with hypertension have their blood pressure adequatelycontrolled.
Methods We analyzed data from the third National Health andNutrition Examination Survey to assess the role of access toand use of health care in the control of hypertension. Hypertensionwas defined as a blood pressure of at least 140/90 mm Hg orthe use of antihypertensive medication.
Results The study sample consisted of 16,095 adults who wereat least 25 years old and for whom blood-pressure values wereknown. We estimated that 27 percent of the population had hypertension,but only 23 percent of those with hypertension were taking medicationsthat controlled their condition. Among subjects with untreatedor uncontrolled hypertension, the pattern was an elevation inthe systolic blood pressure with a diastolic pressure of lessthan 90 mm Hg. The great majority had health insurance. Independentpredictors of a lack of awareness of hypertension were an ageof at least 65 years, male sex, non-Hispanic black race, andnot having visited a physician within the preceding 12 months.The same variables, except for non-Hispanic black race, wereindependently associated with poor control of hypertension amongthose who were aware of their condition. An age of at least65 years accounted for the greatest proportion of the attributablerisk of the lack of awareness of hypertension and the lack ofcontrol of hypertension among those who were aware of theircondition.
Conclusions Most cases of uncontrolled hypertension in the UnitedStates consist of isolated, mild systolic hypertension in olderadults, most of whom have access to health care and relativelyfrequent contact with physicians.
Source Information
From the Departments of Medicine (D.J.H.) and Family and Community Medicine (V.N.P.), Baylor College of Medicine, Houston.
Address reprint requests to Dr. Hyman at the Department of Medicine, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030, or at dhyman{at}bcm.tmc.edu.
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A correction has been published: N Engl J Med 2002;346(7):544.
