Many with hypertension are unaware or untreated
November 18, 2024
Summary: Less than one-third of those with uncontrolled high blood pressure were aware of their diagnosis and treated with medication.
Source: Richardson, et al JAMA Network Open September 11, 2024
High blood pressure is the second leading cause of premature cardiovascular disease (after cigarette smoking). The initial treatment of high blood pressure is diet and exercise, although many will continue to have high blood pressure despite limiting calories and salt and exercising regularly, and many would benefit from treatment with blood pressure medications. According to the National Committee on Quality Assurance, 45% of those on commercial PPOs with a diagnosis of hypertension had blood pressure of over 140/90 at their last office visit.
The most commonly used effective blood pressure medications are taken as pills once a day, have few side effects, and are available generically. Many cost under $100 for a year of treatment. Nonetheless, many with high blood pressure do not even know they have hypertension, and many are not treated adequately to reduce their risk of premature heart attack or stroke. Hypertension is sometimes called the “silent killer” because it may show no symptoms.
Researchers reviewed data from the 2022 NHANES database (National Health and Nutrition Examination Study) to assess how likely people were to know of their hypertension, and what treatment, if any, they received. They found that about half (52%) of those with uncontrolled hypertension were unaware they had high blood pressure, and less than one-third (32%) were both aware of their blood pressure and treated with medication.
Implications for employers:
Better recognition and treatment of high blood pressure could prevent many thousands of premature heart attacks and strokes, and thus prevent medical expense and disability.
Employers that have biometric programs should be sure that those with high blood pressure are referred for treatment.
Medications to treat high blood pressure are not on the Internal Revenue Service preventive medication list, so they cannot be offered without cost sharing in high deductible health plans with tax-advantaged health savings accounts. However, cost is not likely the reason for lack of uptake of these inexpensive medications.
Employers can require their carriers to report on efforts to improve blood pressure control in their population, and to report on current BP results. Blood pressure results require medical record integration or review, as claims data reporting of blood pressure (using ‘z’ codes) is incomplete and can be inaccurate.