Assessing the current status and progress of Healthy People 2020 – an initiative managed by the Office of Disease Prevention and Health Promotion within the U.S. Department of Health and Human Services that set U.S. hypertension goals for adults – a new study published Oct. 20 in Circulation  suggests that hypertension prevalence shows no progress, treatment has exceeded its intended objective, and control has flattened below its target endpoint.

Looking to reduce the burden of cardiovascular disease, Healthy People 2020 was established in 2010 to provide evidence-based, 10-year national objectives for improving the Nation’s health. As part of its 2020 aim, goals were established for decreasing prevalent hypertension to 26.9 percent, treating 69.5 percent of all adults with hypertension, and controlling 61.2 percent of all adults with hypertension.

Analyzing time trends in National Health and Nutrition Examination Surveys 1999-2012 data in two-year blocks of adults ≥18 years old, Brent Egan, MD, Care Coordination Institute and University of South Carolina School of Medicine, and his colleagues found that prevalent hypertension was unchanged (30.1 percent vs. 30.8 percent, p=0.32), hypertension treatment (59.8 percent vs. 74.7 percent, p<0.001) and proportion of treated adults controlled (53.3 percent to 68.9 percent, p=0.0015) increased, and hypertension control to <140/<90 mmHg rose every two years from 1999-2000 to 2009-2010 (32.2 percent vs. 53.8 percent, p<0.001) before declining to 51.2 percent in 2011-2012.

“Our analysis shows that age-adjusted prevalent hypertension has remained at roughly 30 percent of adults from 1999-2012, which is above the Healthy People 2020 goal of 26.9 percent,” notes Egan. “Awareness, treatment, proportion of treated adults controlled, and control of hypertension improved from 1999-2000 to 2011-2012. Yet, these key variables did not change significantly between 2007–2008 and 2011-2012. Specifically, the proportion of treated adults with controlled hypertension has flattened at levels substantially below values required to attain the Healthy People 2020 control goal of 61.2 percent.”

The authors concluded that their analysis “is consistent with previous data that obesity prevention and treatment could reduce incident and prevalent hypertension. Also in agreement with earlier reports, increasing the proportion of adults with health insurance and increasing health care utilization are two modifiable variables independently linked with hypertension treatment and control.”

Moving forward, the authors add that “the new cholesterol guideline, which if implemented would lead to a greater proportion of adults with hypertension on statins, may also [improve prevention efforts]. Ongoing efforts to reduce the proportion of uninsured adults, growth of accountable care organizations, and dissemination and implementation of best practices emerge as potentially useful solutions to reducing these critical gaps and attaining the Healthy People 2020 hypertension control goal.”

Keywords: United States Dept. of Health and Human Services, Adult, Health Promotion, Medically Uninsured, Accountable Care Organizations, Obesity, Insurance, Health, Nutrition Surveys, Cost of Illness, Hypertension