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Both awareness and control of hypertension had gone back into decline as of 2017-2018, according to National Health and Nutrition Examination Survey (NHANES) data.

The estimated proportion of hypertensive U.S. adults who had their blood pressure (BP) controlled to under 140/90 mm Hg improved from 31.8% in 1999-2000 to 48.5% in 2007-2008 (P<0.001), which then crept up to 53.8% in 2013-2014 (P=0.14). After that, however, control started on a downward trajectory to 43.7% in 2017-2018 (P=0.003), reported a team led by Paul Muntner, PhD, of the University of Alabama at Birmingham in .

Among adults with hypertension, an estimated 69.9% said they knew they had hypertension in 1999-2000, increasing to 84.7% in 2013-2014 but then declining to 77.0% in 2017-2018.

Similarly, in the subgroup of people who reported being aware they had hypertension, the estimated proportion who said they were taking antihypertensive medications increased from 85.0% in 1999-2000 to 92.7% in 2009-2010 and dropped to 88.2% in 2017-2018.

Coinciding with the release of Muntner's study was a that also found declining rates of BP control using NHANES data. That report is one of the highlights of the American Heart Association (AHA) taking place virtually later this week.

"In light of the disappointing data of Muntner and colleagues on awareness and control of hypertension, new clinical practice guidelines should provide clinicians with a fresh blueprint for more effective management of hypertension and prevention of its adverse health consequences," said an editorial from Gregory Curfman, MD, and fellow senior JAMA editors.

The good news is that the NIH and various professional societies "have committed substantial resources to the diagnosis and treatment of hypertension," they said, urging these programs to report how many patients have been diagnosed and how many have been effectively treated.

Notably, hypertension in the study was not defined by the lower 130/80 mm Hg threshold recommended by the American College of Cardiology (ACC) and AHA in 2017.

"With a higher proportion of adults taking antihypertensive medication and more intensive treatment recommended for those with hypertension, the implementation of the 2017 ACC/AHA BP guideline could result in increasing hypertension awareness, antihypertensive medication use, and BP control," Muntner's group said.

The study included 51,761 NHANES participants, of whom 18,262 had hypertension (defined as systolic BP 140 mm Hg or higher, diastolic BP 90 mm Hg or higher, or use of antihypertensive medication).

Overall, the NHANES cohort averaged 48 years of age and was evenly split between sexes. The group was 43.2% White, 21.6% Black, 5.3% Asian, and 26.1% Hispanic.

Muntner's group weighted the analyses to be representative of U.S. adults.

BP control was generally more likely for those age 45-64 compared with younger and older groups, for those with private or government insurance, for people with a usual health care facility, and for those who had had a health care visit in the past year.

Among those taking antihypertensive medication, BP control was more likely for Whites compared with Blacks or Asians, and those ages 18-44 years compared with those 65 or older.

Despite BP readings being taken after 5 minutes of seated rest and with three measurements obtained at 30-second intervals, hypertension was determined for each NHANES participant based on measurements over only a single visit, Muntner's group acknowledged.

Plus, the association of lifestyle factors with BP control couldn't be examined given that data on diet, medication adherence, adverse effects, insurance reimbursement for medications, and use of home BP monitoring were not available.

Another limitation was that the NHANES response rate declined from 76% in 1999-2000 to 49% in 2017-2018, although it is unclear what effect this may have had on the findings.

"It will be crucial to repeat the analyses of Muntner et al in another 5 years to determine whether progress has been achieved, with direction provided by the 2017 U.S. and 2018 European guidelines, to control the serious global health consequences of hypertension," according to the JAMA editors.

"In the midst of the worldwide COVID-19 pandemic in which elevated BP level is a major comorbidity, it is especially important that clinicians and health care systems not be complacent about the control of hypertension," they continued.

Ultimately, a discussion of COVID-19, problems in hypertension control, and the slowdown in reducing cardiovascular mortality must address socioeconomic or racial disparities, suggested a separate editorial from Griffin Rodgers, MD, and Gary Gibbons, MD, both of the NIH in Bethesda, Maryland.

"If the U.S. 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," Rodgers and Gibbons wrote.

"It will take a collective, committed effort at every level, including policy makers, frontline , 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," they added.

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