Hypertension poorly controlled in most patients despite treatment

Hypertension is not well controlled in most patients with the condition despite treatment, according to an analysis including almost 100,000 UK adults.

The analysis looked at 40-69-year-old patients who had been previously diagnosed with and prescribed treatment for high blood pressure, finding that only two in five were controlled to a target of under 140/90 mmHg.

The analysis was based on baseline survey data from the the UK Biobank population study of half a million adults across England, Scotland and Wales between 2006 and 2010.

Writing in the Open Heart journal, the researchers said people who were over the age of 60, of black ethnicity, and who are on relatively low incomes of less than £18,000 a year were less likely to have well controlled blood pressure.

By contrast, having co-existing conditions was most strongly associated with blood pressure control, the data showed.

In all 56% of participants had a blood pressure reading above 140/90 mm Hg but almost half of those were unaware they had hypertension. Of those who were aware they had high blood pressure, 27% were not taking medication to treat it.

The final analysis included those who did know about their condition and were on medication. They had an average age of 62 and 46% were women, the researchers reported.

Figures also showed that 19% had been diagnosed with cardiovascular disease, 40% were obese and 9% were current smokers. 

The researchers found that 38% of those on treatment were well controlled.

When a higher cut off of 160/100 mm Hg was applied, 21% were not properly treated, the researchers said.

They concluded that the findings may help to identify subgroups ‘for which clinical practice improvement efforts can be targeted’.

‘In one of the largest population-based analyses in middle-aged adults, the majority of individuals treated for hypertension were not controlled.

‘Older, black and lower-income hypertensives were less likely to be controlled, while those with multimorbidity and at increased CVD risk were more likely to be controlled.’

The team called for more research to understand the barriers to hypertension control and the link between blood pressure control and other co-morbidities.

This comes as GPs saw the introduction of new hypertension QOF indicators in 2019 which dropped the threshold for patients aged under 80 to 140/90 mmHg.. Previously practices had earned points for patients with hypertension whose blood pressure was under 150/90 mmHg.