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Implications for Health Care Policy, Education, and Research

Brent M. Egan, MD; Daniel T. Lackland, DrPH; Neal E. Cutler, PhD

Arch Intern Med. 2003;163:681-687.

Background  The prevalence of high blood pressure (HBP), particularly isolated systolic hypertension, rises with age, whereas control rates decline.

Methods  Since awareness, knowledge, and attitudes about HBP can influence control, information on these factors was obtained by telephone interview of a nationally representative sample of 1503 adults 50 years or older.

Results  Among Americans 50 years or older, 94% had at least one blood pressure (BP) measurement during the past year, yet 46% did not know their BP. Only 27% acknowledged current HBP, although 37% reported taking antihypertensive medications. Systolic hypertension was probably underrecognized, since 30% who reported a value of 140 mm Hg or higher indicated they did not have HBP. Among those acknowledging current HBP, 80% reported taking medications "precisely as prescribed." Of the approximately 20% of hypertensive patients no longer taking medications or taking fewer medications than prescribed, cost was a major factor in approximately 1 in 5 or roughly 4% of the total. Sixty percent of patients receiving treatment indicated that medications alone do not control HBP. Most survey respondents (90%) concurred that several lifestyle changes lower BP; 75% reported a lifestyle change; and 61% indicated it lowered their BP. When asked what HBP information was most important, 34% reported alternative therapies and 28% reported prevention strategies.

Conclusions  Limited awareness of systolic hypertension emerges as a greater barrier to BP control than cost of medications in Americans 50 years or older. Many older Americans prefer to integrate traditional, complementary, and alternative strategies. Education addressing limited awareness of systolic hypertension, policies facilitating a more holistic management approach, and research identifying the most effective innovations may improve outcomes.

From the Departments of Medicine (Dr Egan), Pharmacology (Dr Egan), and Biometry Epidemiology (Dr Lackland), Medical University of South Carolina, Charleston; National Council on the Aging, Washington, DC (Dr Cutler); and Department of Financial Gerontology, Widener University, Chester, Pa (Dr Cutler).

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