Men, Leaner Folks Less Likely to Be Treated for High BP

(MedPageToday.com) — Men and patients who are leaner and generally healthier are less likely to have their hypertension treated, researchers said.

Male sex, body mass index (BMI) below 25 kg/m², lack of chronic kidney disease, lower heart disease risk, and making fewer visits to the doctor were associated with high blood pressure going untreated, Brent Egan, MD, of the Medical University of South Carolina in Charleston, and colleagues reported online in Circulation: Journal of the American Heart Association.

When patients were treated, those whose hypertension remained uncontrolled on one or two medications were more likely to be older and have a greater risk of heart disease, while those who were treatment-resistant (uncontrolled on three drugs or more) also had a higher risk of heart disease; but they went to the doctor more frequently, were obese, and had chronic kidney disease, too.

Defining the characteristics of these uncontrolled hypertensive patients may facilitate efforts to improve blood pressure control, the researchers said.

“Overall, physicians are doing a very good job treating and controlling hypertension,” Egan said in an email to MedPage Today. “Yet there is still room for improvement.”

Although the proportions of untreated and uncontrolled hypertensive patients have fallen in recent years, more than 30 million hypertensive patients remain uncontrolled in the U.S., they said.

In order to define the characteristics of both groups of patients, the researchers looked at data on 13,375 hypertensive adults from three periods of the National Health and Nutrition Examination Survey (NHANES): 1988-1994, 1999-2004, and 2005-2008.

Overall, the proportion of uncontrolled hypertensive patients fell from 73.2% in 1988-1994 to 52.5% in 2005-2008.

Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits, BMI of 25 kg/m² or below, absence of chronic kidney disease, and 10-year Framingham heart risk below 10% (P<0.01 for all).

Egan and colleagues said that infrequent healthcare visits is a major issue in this population, with a mean of more than 40% of untreated hypertensive patients in all survey periods reporting none or just one trip to the doctor annually.

This finding suggests that increasing health care use in all settings “is critical in reducing the burden of untreated hypertension,” they wrote. “Raising the perceived value of regular preventive health care services among those without clinically overt disease emerges as an important complementary educational strategy.”

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