Arrows Pointing Up on Hypertension Treatment in DFW

Dallas-Fort Worth has made in-roads to hypertension awareness and treatment, according to a study by the Institute for Health Metrics and Evaluation (IHME).

Hypertension prevalence rose in Dallas, Tarrant, Collin and Denton counties between 2001 and 2009. However, awareness, treatment and control also increased, according to IHME’s study of U.S. counties. Many experts attribute the increase in prevalence to greater awareness of the problem.

In Dallas County, about 37 percent of men and more than 40 percent of women had hypertension in 2009. However, more than 7 out of 10 are receiving treatment and more than half have their conditions under control by taking prescribed medications.

The rates were similar in Tarrant County while prevalence was lower in Collin and Denton counties.

About 8 out of 10 hypertension sufferers knew about their condition, while the remainder have the condition but are unaware of it.

IHME analyzed hypertension data by county, sex, and race for adults over 30 in the US from 2001 to 2009. Across US counties, the median rate of hypertension prevalence for men in 2009 was about 38 percent and county-level rates ranged from less than 27 percent in Eagle County, Colorado, to more than 54 percent in Holmes County, Mississippi.

These findings build on work IHME released in 2011 and 2012 that provided county-level life expectancy estimates for the past two decades, showing that women were faltering in comparison to the improvements in life expectancy seen in Europe and the high-income countries of the Pacific.

“By identifying these rising blood pressure rates, now we can see the evidence for why life expectancies are stagnating in hundreds of counties nationwide,” said Ali Mokdad, MD, one of the study’s authors.

Researchers also found significant regional disparities in hypertension treatment and control:

  • Texas had some of the highest disparities among counties in treatment levels for both men and women, although that was not the case in DFW.
  • California had treatment levels below the national averages for both men and women while Florida had rates of uncontrolled hypertension for both sexes that were higher than the national averages.
  • Counties in four states accounted for the 10 highest rates of hypertension prevalence — Alabama, Georgia, Louisiana, and Mississippi — but the percentage of people in those states whose hypertension was being treated or was controlled increased between 2001 and 2009.

In addition to geographic disparities, the study also found disparities due to gender and race. Black men and women had the highest total prevalence of hypertension, at 51 percent and 54 percent, respectively. Prevalence rates for Hispanic men were about 38 percent and 43 percent for Hispanic women.

In Dallas County, 34.5 percent of white men and 36.2 percent of white women had hypertension. Those rates were 13 and 15 percentage points higher for black men and black women, respectively. Rates for Hispanic men and women were only slightly higher than that of whites.

According to a separate Centers for Disease Control study, hypertension is significantly higher among seniors, and those with less than a high school education, compared with younger people and people with higher levels of education.

Hypertension is a major risk factor for heart disease and stroke. Improving hypertension awareness and initiating appropriate treatment are important to increase blood pressure control and reduce risk for heart disease and stroke. The findings in this study provide public health practitioners information to help target blood pressure control efforts.

Mark Peterman, MD, interventional cardiologist and medical director of cardiovascular services at Texas Health Presbyterian Hospital Plano, credited public-awareness campaigns and the increasing availability of generic and combination pills for treatment progress.

Tu Le, MD, cardiovascular disease specialist and member of Texas Health Physicians Group, said, “ As health care coverage expands under the Affordable Care Act, there will be a tremendous influx of the population into the health care system. This may impact the statistics tremendously with a higher prevalence of the disease as more reporting may occur. It would also be interesting to see whether there would be a positive or negative impact on the controlled hypertension group within accountable care organization initiatives.”

Cara East, MD, a cardiologist who practices at Baylor Heart and Vascular Hospitals, said widespread availability of blood-pressure screening in pharmacies and at home might be contributing the prevalence rate.

“In studies to date, it does not seem to matter whether the BP is lowered by lifestyle (such as exercise, low salt diet, and weight loss) or medicines, but it does matter that we get BP into the ideal range,” she said.

Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

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