Approximately 50 million persons in the United States have high blood pressure (1). Despite substantial increases in the awareness and treatment of hypertension, 79% of persons with hypertension do not have their blood pressure under control (1). A national health objective for the year 2000 is to increase to at least 90% the proportion of persons with hypertension who are "taking action" to help control their blood pressure (objective 15.5) (2). This report summarizes data from CDC's National Health Interview Survey (NHIS) on the proportion of persons with hypertension who are taking action to control their blood pressure and on factors associated with taking action.

In 1990, the NHIS Health Promotion and Disease Prevention Supplement included 36,610 respondents aged greater than or equal to 18 years. This survey included 8697 persons who reported having been told by a physician that they had high blood pressure. Persons were asked whether a physician had advised them to take antihypertensive medication, limit their intake of dietary salt, reduce weight, and/or exercise to control their blood pressure. They were asked whether they were currently following any of these recommendations; persons who answered "yes" were defined as taking action to control their blood pressure. The results were statistically weighted for national representation. SESUDAAN (3) and RTILOGIT (4) were used to calculate standard errors for the prevalence estimates and odds ratios.

Of the 8697 respondents with hypertension, 7714 (89%) reported receiving some type of advice from a physician to control blood pressure (Table_1). The most commonly received advice was using antihypertensive medication (73%) and limiting salt intake (68%). Less than half of the respondents reported receiving advice to exercise (48%) or lose weight (46%).

Overall, 80% of persons with hypertension reported currently taking at least one action to control their blood pressure (Table_1). Most frequently reported actions were limiting salt intake (61%) and taking antihypertensive medication (56%); one third (33%) reported engaging in exercise.

Almost all respondents (90%) who were advised to take some form of action reported complying with at least one recommendation. Compliance with specific advice ranged from decreasing weight (67%) to limiting salt intake (89%).

Persons aged greater than or equal to 65 years were five times more likely than persons aged 18-34 years to report having taken action (Table_2). Among men aged 18-34 years, 55% of blacks and 51% of whites reported taking some action to control blood pressure. As the length of time since a respondent's last visit to a physician increased, the likelihood of taking action decreased. Persons who had not visited a physician within the preceding 2 years were 60% less likely to take action than persons who had visited a physician within the preceding year. Persons who reported their health status as good, fair, or poor were substantially more likely to take action than were persons who reported their health status as excellent.

Reported by: Cardiovascular Health Studies Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Persons with hypertension are at increased risk for coronary artery disease, congestive heart failure, transient ischemic attacks, stroke, renal failure, and retinopathy (1). The findings in this report indicate that the proportion of persons taking action to control their blood pressure is lower than the national health objective.

Specific national health objectives have been established to narrow the disparities in health between the total population and certain groups at increased risk for disease, disability, and death. One health objective for the year 2000 is to increase to at least 80% the proportion of young (aged 18-34 years) white and black men * with hypertension who are taking action to control their blood pressure (objectives 15.5a and 15.5b) (2). The findings in this report indicate that substantial progress will be needed to achieve this objective. Health-care providers may have to make special efforts to convince younger adults of the importance of controlling hypertension. Findings from this study also suggest that similar efforts may be needed for persons with hypertension who perceive that they are generally in excellent or very good health.

Having a regular source of medical care and having seen a physician within the preceding year were strongly associated with taking action to control blood pressure. Lack of access to preventive health care also has been associated with an increased frequency of hypertensive emergencies and uncontrolled hypertension (5). These findings underscore the importance of increasing access to health care for all persons in the United States.

Lifestyle modifications (e.g., limiting salt intake, reducing weight, and increasing physical activity) are effective in lowering blood pressure (6,7). However, most persons with hypertension in this study did not recall being advised by a physician to exercise. The low proportion of persons who recalled having received advice about physical activity may reflect insufficient training of many health-care providers in counseling patients about physical activity (8). Compared with medication costs, physical activity is a less costly means of lowering blood pressure and decreasing the risk for cardiovascular disease. Medication costs, which can account for 80% of the expenses associated with treating hypertension, may be a barrier to persons who want to control their blood pressure (1).

To achieve the year 2000 objective for taking action to control blood pressure, additional public health efforts should target young men with hypertension and persons without access to preventive health care. Use of data from national surveys, such as the NHIS, will help measure progress toward this objective. Additional information about high blood pressure is available from the American Heart Association, telephone (214) 373-6300, or the National High Blood Pressure Education Program, telephone (800) 575-9355 ({301} 251-1222).

References

1. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993;153:154-83.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

3. Shah BV. SESUDAAN: Standardized errors programs for computing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

4. Shah BV, Folsom RE, Harrell FE, Dillard CN. RTILOGIT: procedure for logistic regression on survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1984.

5. Shea S, Misra D, Ehrlich MH, Field L, Francis CK. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med 1992;327:776-81.

6. Treatment of Mild Hypertension Research Group. The Treatment of Mild Hypertension Study: a randomized, placebo-controlled trial of a nutritional-hygienic regime along with various drug monotherapies. Arch Intern Med 1991;151:1413-23.

7. Wasertheil-Smoller S, Blaufox MD, Oberman AS, Langford HG, Davis BR, Wylie-Rosett J. The Trial of Antihypertensive Interventions and Management (TAIM) Study: adequate weight loss, alone and combined with drug therapy in the treatment of mild hypertension. Arch Intern Med 1992;152:131-6.

8. Henry RC, Ogle KS, Snellman LA. Preventive medicine: physician practices, beliefs, and perceived barriers for implementation. Fam Med 1992;19:110-3.

* Objectives for this subpopulation of young men were established only for whites and blacks because data were not available for other racial/ethnic groups.

Table_1
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Percentage of adults with hypertension advised and taking action to control
blood pressure -- United States, National Health Interview Survey, 1990
======================================================================================
                             Advised       Taking action     Compliance *
Physician                 ------------     --------------    ------------
  recommendation           No.     %        No.      %            %
-------------------------------------------------------------------------
Antihypertensive
  medication              6349  (73.0)     4862    (55.9)       (76.6)
Decrease salt intake      5905  (67.9)     5270    (60.6)       (89.2)
Decrease weight           3966  (45.6)     2670    (30.7)       (67.3)
Exercise                  4166  (47.9)     2653    (32.8)       (68.5)
Any +                     7714  (88.7)     6958    (80.0)       (90.2)
------------------------------------------------------------------------

* The number of persons who are currently taking action divided by the total
  number of persons advised to take action, multiplied by 100.
+ Defined as antihypertensive medication, decreased salt intake, decrease weight,
  or exercise.
======================================================================================

TABLE 2. Factors associated with taking action * to control blood pressure --
United States, National Health Interview Survey, 1990
===================================================================================
Category            Sample size    Prevalence      OR +    95% CI &
--------------------------------------------------------------------
Age group (yrs)
  18-34                 1127          56.0%        1.0     Referent
  35-49                 1848          72.6%        1.8     (1.5-2.2)
  50-64                 2363          86.4%        3.9     (3.2-4.8)
   >=65                 3359          89.7%        5.0     (4.1-6.1)

Sex
  Women                 5179          83.2%        1.0     Referent
  Men                   3518          76.5%        0.9     (0.8-1.0)

Race @
  White                 7030          79.6%        1.0     Referent
  Black                 1667          82.5%        1.4     (1.2-1.7)

Education (yrs)
  <12                   2673          83.7%        1.0     Referent
   12                   3258          79.6%        1.1     (0.9-1.4)
  >12                   2766          77.3%        1.1     (0.9-1.4)

Region **
  Northeast             1744          82.2%        1.0     Referent
  Midwest               2375          78.6%        0.8     (0.7-1.0)
  South                 3141          80.0%        0.9     (0.7-1.0)
  West                  1437          79.5%        0.9     (0.7-1.2)

Have regular source of
  medical care
  No                     904          68.4%        1.0     Referent
  Yes                   7793          82.7%        1.9     (1.5-2.3)

Last physician visit (yrs)
   <1                   7713          83.0%        1.0     Referent
  1-2                    441          66.3%        0.6     (0.5-0.8)
   >2                    543          54.2%        0.4     (0.3-0.5)

Self-reported health status
  Excellent             1601          68.3%        1.0     Referent
  Very good             2199          77.2%        1.3     (1.1-1.5)
  Good                  2789          84.1%        1.8     (1.4-2.1)
  Fair                  1460          86.2%        1.7     (1.4-2.2)
  Poor                   648          89.4%        2.1     (1.5-3.0)

Total                   8697          80.0%        --         --
--------------------------------------------------------------------
 * Action is defined as currently taking antihypertensive medication, limiting
   salt intake, reducing weight, and/or exercising as a means to control blood
   pressure.
 + Odds ratio. Model is adjusted for age, sex, race, education, region, regular
   source of medical care, last physician visit, and self-reported health status.
 & Confidence interval.
 @ Numbers for other racial/ethnic groups were too small for meaningful analysis.
** Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New
   York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana,
   Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio,
   South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of
   Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North
   Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West
   Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana,
   Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
===================================================================================

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