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• W2065956402 abstract "HomeHypertensionVol. 53, No. 3Upward Hypertension Trends: Changes in Blood Pressure or in Antihypertensive Treatment? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBUpward Hypertension Trends: Changes in Blood Pressure or in Antihypertensive Treatment? Arnaud Chiolero Fred Paccaud and Pascal Bovet Arnaud ChioleroArnaud Chiolero Institute of Social and Preventive Medicine, University Hospital Center, and University of Lausanne, Lausanne, Switzerland, and, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada Search for more papers by this author Fred PaccaudFred Paccaud Institute of Social and Preventive Medicine, University Hospital Center, and University of Lausanne, Lausanne, Switzerland Search for more papers by this author and Pascal BovetPascal Bovet Institute of Social and Preventive Medicine, University Hospital Center, and University of Lausanne, Lausanne, Switzerland Search for more papers by this author Originally published26 Jan 2009https://doi.org/10.1161/HYPERTENSIONAHA.108.126870Hypertension. 2009;53:e22Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 26, 2009: Previous Version 1 To the Editor:Using population-based data gathered as part of National Health and Nutrition Examination Surveys, Cutler et al1 showed that the age-adjusted prevalence of hypertension increased from 24.4% to 28.9% in the United States between 1988–1994 and 1999–2004, an absolute increase of 4.5%. A large part of this increase was attributed to the rising prevalence of obesity.Interestingly, the proportion of persons under hypertensive treatment substantially increased during the period under study.1 The age-standardized prevalence of persons taking antihypertensive medications was not provided. However, based on crude estimates (kindly provided by the authors), we can estimate that the prevalence of treatment has increased from 12.2% to 17.8%, ie, by 5.6%. This is larger than the increase in the prevalence of hypertension (defined as high blood pressure or treatment). Meanwhile, high blood pressure (≥140/90 mm Hg, with or without treatment) rose by 1.8% (from 17.0% to 18.8%, crude estimates).If the proportion of persons treated had not increased, would the prevalence of hypertension have increased commensurably? This is questionable.First, the prevalence of hypertension can increase irrespective of true blood pressure levels if the prevalence of treatment increases, because, by definition, treated patients are counted as hypertensive irrespective of blood pressure levels. Conversely, an increase in the prevalence of hypertension, so defined, does not necessarily reflect any increase in the average blood pressure in the population.Second, there has likely been a trend over time to treat patients at increasingly lower levels of blood pressure, eg, “mild” hypertension.2,3 This partly reflects the increase in the proportion of the population that has blood pressure controlled. However, this also may have fueled an increase in the prevalence of hypertension. Diagnosis uncertainty of hypertension is high and may lead to inappropriate treatment.4,5 Because the probability of overdiagnosis of hypertension is greater in the case of mild hypertension than severe hypertension,4 overdiagnosis (and overtreatment) may be more frequent at the end of the period under study than at the beginning.It is admittedly difficult to disentangle actual blood pressure trends that would have occurred irrespective of treatment, because the characteristics and number of persons treated and the type of treatment have changed over time.2,3 At the extreme, the prevalence of hypertension could increase, whereas mean blood pressure levels in the population may actually decrease. For instance, Cutler et al1 reported that mean systolic blood pressure in men did not change, and diastolic blood pressure actually decreased by 3 mm Hg, whereas the prevalence of hypertension largely increased.1 These considerations underlie the need to carefully interpret trends in the prevalence of hypertension in populations, notably by taking into account trends in treatment prevalence, changes in treatment strategies, and diagnosis uncertainty.Source of FundingA.C. is supported by a grant from the Canadian Institute of Health Research.DisclosuresNone.1 Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension. 2008; 52: 818–827.LinkGoogle Scholar2 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, and the National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206–1252.LinkGoogle Scholar3 Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM, Narayan KM, Williamson DF. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA. 2005; 293: 1868–1874.CrossrefMedlineGoogle Scholar4 Pater C. Beyond the evidence of the New Hypertension Guidelines. Blood pressure measurement—is it good enough for accurate diagnosis of hypertension? Time might be in, for a paradigm shift (I). Curr Control Trials Cardiovasc Med. 2005; 6: 6.CrossrefMedlineGoogle Scholar5 Campbell N, Culleton B, McKay D. Misclassification of blood pressure by usual measurement in ambulatory physician practices. Am J Hypertens. 2005; 18: 1522–1527.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Roulet C, Bovet P, Brauchli T, Simeoni U, Xi B, Santschi V, Paradis G and Chiolero A (2016) Secular trends in blood pressure in children: A systematic review, The Journal of Clinical Hypertension, 10.1111/jch.12955, 19:5, (488-497), Online publication date: 1-May-2017. Valderrama A, Tong X, Ayala C and Keenan N (2010) Prevalence of Self-Reported Hypertension, Advice Received From Health Care Professionals, and Actions Taken to Reduce Blood Pressure Among US Adults-HealthStyles, 2008, The Journal of Clinical Hypertension, 10.1111/j.1751-7176.2010.00323.x, 12:10, (784-792) Cutler J and Sorlie P (2009) Response to Upward Hypertension Trends: Changes in Blood Pressure or in Antihypertensive Treatment?, Hypertension, 53:3, (e23-e23), Online publication date: 1-Mar-2009. March 2009Vol 53, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/HYPERTENSIONAHA.108.126870PMID: 19171790 Originally publishedJanuary 26, 2009 PDF download Advertisement SubjectsEpidemiologyHypertension" @default.
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