Pressure Check

A Reversal in Blood Pressure Control for Americans

Let’s face facts. We’re losing ground in control of blood pressure and thus in a key measure of heart health. A new study in JAMA last week documented a decline in U.S. rates of well-controlled blood pressure in 2018. This is a reversal of positive trends that spanned decades. This comes before the health impact of COVID-19. We’ll hazard a guess that things are getting worse, not better, now.

At the same time, researchers from CDC published a new analysis of data on obesity prevalence by race and ethnicity. The rates continue to grow and most distressingly so among Black and Hispanic teens. In fact, those two groups were the primary drivers of growth in obesity among teens.

Erasing Decades of Progress

Between 1999 and 2008, more Americans gained better control of their blood pressure. Among people with hypertension, the portion with good control rose from 32% to 49%. In 2014, that number had stayed about the same – 54 percent. But in 2018, it dropped 44 percent – a startling decline. Gregory Curfman, Howard Bauchner, and Philip Greenland explain the seriousness in an editorial for JAMA:

Given that more cardiovascular events are attributable to hypertension than any other modifiable risk factor, these data showing a decline in awareness and control are of major public health concern.

Obvious Disparities

But when you dig deeper into these reports, they paint an even worse picture of disparities in health. People who lack health insurance have the highest rates of uncontrolled hypertension – nearly 80 percent. With the lowest levels of income, people have the least control of their blood pressure. Black and Hispanic Americans likewise have the lowest rates of adequate control. Disparities in obesity and its trends will only make this worse. On top of that, COVID-19 is adding further disparities in health. From NIH, Griffin Rodgers and Gary Gibbons draw the connection to systemic racism:

If the US is committed to changing the trend line of health disparities in obesity and hypertension, it is critical to acknowledge the important contributions of systemic racism and the social determinants of health in the context of the current COVID-19 crisis. It will take a collective, committed effort at every level, including policy makers, frontline community organizations, health care workers at safety-net clinics, and those conducting behavioral and biomedical scientific research, to address these potentially remediable contributors to some of the nation’s most complex health challenges. Only then will it be possible to achieve a vision of health equity in which each child born in the US is destined to live a full and healthy life regardless of their family’s zip code.

Ready for Change?

Are we serious about change? Our actions will tell. But right now, health is a privilege dispensed according to race, ethnicity, and wealth in America. This is a profound embarrassment.

Click here for the study of hypertension trends and here for the new data on obesity. The editorial by Curfman et al is here and for the Rodgers/Gibbons editorial, click here. Finally, for further reporting from Medscape, click here.

Pressure Check, U.S. Air National Guard photograph by Master Sgt. Matt Hecht / flickr

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September 17, 2020

4 Responses to “A Reversal in Blood Pressure Control for Americans”

  1. September 17, 2020 at 6:37 am, Beverly Lynn said:

    Do these findings take into account the changes in 2017 which redefines high blood pressure at 130/80 , down from 140/90?

    • September 17, 2020 at 6:41 am, Ted said:

      This analysis uses a common definition across time. Control = BP < 140/90.

  2. September 17, 2020 at 8:18 pm, Chester Draws said:

    But right now, health is a privilege dispensed according to race, ethnicity, and wealth in America.

    Not dispensed.

    There are plenty of rich sick people, and plenty of healthy poor people.

    There’s a correlation, nothing more.

    • September 18, 2020 at 4:49 am, Ted said:

      Extensive research on social determinants of health suggests that the connections between health, wealth, and social status might be more than “nothing,” Chester.