In Reply: Drs Berlowitz and Cushman and Mr Glassman are correct in pointing out that improvements were made in blood pressure control among some subgroups during the decade of the 1990s; the VA experience that they cite is a remarkable example. Major systematic efforts were required to achieve these impressive results. Unfortunately, the success of the VA with regard to hypertension control was not mirrored in the community or in the nation as a whole during the 1990s. Data from the nationally representative NHANES samples reveal that, among all patients with hypertension, blood pressure control rates increased from approximately 25% between 1988 and 1991 to only 31% between 1999 and 2000.1 In the Framingham observational cohorts, using the same data set as in our article, we observed statistically significant increases in prevalence of blood pressure control (defined as blood pressure <140 mm Hg/<90 mm Hg) among all patients with hypertension during the 1990s, from 25% to approximately 40% (P<.001). The youngest group of patients with hypertension (those 60 years or younger) had the largest increase in control rates, to levels in excess of 50%, whereas older patients with hypertension had smaller increases, to rates in the 35% to 40% range. We await systematic improvements and greater public health and clinical efforts at blood pressure control in order to reduce the risks associated with hypertension that we reported.
Lloyd-Jones DM, Evans JC, Levy D. Hypertension in Adults Across Age Groups—Reply. JAMA. 2005;294(23):2970–2972. doi:10.1001/jama.294.23.2971-b
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