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October 7, 2020

A National Commitment to Improve the Care of Patients With Hypertension in the US

Author Affiliations
  • 1Office of the Surgeon General, Department of Health and Human Services, Washington, DC
JAMA. 2020;324(18):1825-1826. doi:10.1001/jama.2020.20356

Hypertension is common, costly, and controllable. Almost 1 in 2 US adults has hypertension, and among those, the estimated rate of controlled blood pressure was only 43.7% in 2017-2018 a decline from 53.8% in 2013-2014.1 Uncontrolled blood pressure can lead to largely preventable events such as myocardial infarction, stroke, and maternal mortality, as well as debilitating and expensive conditions such as kidney disease, heart failure, and cognitive decline. Hypertensive disorders of pregnancy, which have increased in the US, contribute to adverse maternal and child health outcomes and can increase a woman’s lifetime risk of cardiovascular disease. Disparities in blood pressure control and, consequently, in these health outcomes, persist by race and ethnicity, age, and geography. Yet broad and equitable hypertension control is possible, and some health care practices and systems have achieved rates of 80% or higher across a wide spectrum of sites and populations served.2-5

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    1 Comment for this article
    The More Things Change
    Michael Mundorff, MBA, MHSA | integrated healthcare system
    I believe part of the confusion among patients, which may drive reluctance about treatment, is the many guidelines which are sometimes conflicting and always changing over time. The lay press' breathless and often uncritical coverage of them is not helpful. For example, the USA’s ACP states that a systolic blood pressure (SBP) above 130 requires (not necessarily pharmacologic) treatment, while the EU puts that bar at an SBP of 140. Then a recent large study demonstrated there is a sliding-scale risk of adverse events for an SBP higher than 90, which would include most adults. So part of the Surgeon General’s task should be to clarify all of these conflicts and advocate what that department believes to be the best course for patients, supported by current evidence.