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(Hypertension. 2009;53:e22.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Upward Hypertension Trends: Changes in Blood Pressure or in Antihypertensive Treatment?

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

Fred Paccaud; Pascal Bovet

Institute of Social and Preventive Medicine, University Hospital Center, and University of Lausanne, Lausanne, Switzerland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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 . . . [Full Text of this Article]

This article has been cited by other articles:

				J. A. Cutler and P. D. Sorlie Response to Upward Hypertension Trends: Changes in Blood Pressure or in Antihypertensive Treatment? Hypertension, March 1, 2009; 53(3): e23 - e23. [Full Text] [PDF]