Death rates among those with high blood pressure decreasing, but still high

"Mortality rates are going down for everybody with high blood pressure, but despite the availability of several types of medication to reduce blood pressure, there is still a large gap between those with hypertension and those without," said Earl S. Ford, M.D., M.P.H., study author and medical officer with the U.S. Public Health Service at the Centers for Disease Control and Prevention.

Ford examined changes in death rates among adults ages 25-74, using results from two national health surveys. The National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study followed participants recruited between 1971 and 1975. The NHANES III Linked Mortality Study followed participants recruited between 1988 and 1994.

The study found:

• The overall death rate (number of deaths for every 1000 person-years and adjusted for age) was 18.8 among NHANES I participants with high blood pressure -- 42 percent higher than in those without it (13.3).
• From NHANES I until NHANES III, mortality rates had fallen to 14.3 in hypertensive patients -- 57 percent higher than in those without high blood pressure (9.1).
• Although men were more likely to die than women in both time periods, the decline in deaths among hypertensive men (7.7, a 33 percent relative reduction) was more than four times larger than among hypertensive women (1.9, a 12 percent relative reduction).

"On average, hypertensive women had larger declines in their blood pressure than hypertensive men, but didn't do as well in other measures related to heart disease risk," Ford said. "Compared with hypertensive men, women gained more weight, were more likely to be diagnosed with diabetes and were less likely to quit smoking."

Between the two surveys, hypertensive patients had a:

• 45 percent smaller reduction in total cholesterol levels
• 30 percent larger increase in body mass index
• 3.6 times larger increase in the diagnoses of diabetes
• 25 percent larger decrease in the percentage of smokers

"The mortality gap that remains despite improved treatment means that hypertensive patients need to be aggressively monitored for risk factors other than blood pressure, with efforts made to reduce the total burden of heart disease risks," Ford said.

"In addition to taking steps to lower your blood pressure, if you have hypertension, you should stop smoking, control your weight as well as you can, have your lipid levels measured (and if needed, be treated), and get tested for diabetes."