US Better Than Europe at Controlling Hypertension

According to a report published in the January 22 issue of Archives of Internal Medicine, diagnosis, treatment and control of hypertension is better in the United States than in Western European countries. The study found that individuals with diagnosed hypertension in the United States had better control over their condition than those in Europe.

Hypertension or high blood pressure affects millions. It is also a strong risk factor for cardiovascular disease. Previous studies have found that the levels of diagnosis and treatment of hypertension in both the US and Europe are low compared to what they should actually be. As compared to other countries, the US is generally believed to have more aggressive guidelines regarding the blood pressure level at which treatment for hypertension should begin.

The study was conducted by Dr. Y. Richard Wang from the Temple University Hospital and University of Pennsylvania and colleagues using data from a survey of patients with hypertension. The patients were registered with 291 cardiologists and 1,284 primary care physicians in the US and five Western European countries including France, Germany, Italy, Spain and the United Kingdom.

The physicians were randomly selected and volunteering physicians asked to complete two-page diaries for 15 of their cardiovascular patients. Information such as patient characteristics, initial blood pressure level before treatment, any co-occurring diseases and the use of various types of anti-hypertensive drugs was collected for each patient.

Data was collected for a total of 21,053 patients across the six countries, of which 53% were male and 23% had diabetes. The average age of the study population was 65 years. At least 92% of the hypertension patients in all countries were receiving some medication for their condition. Figures for blood pressure level prior to treatment were available for between 61% and 80% of patients in each country.

The researchers found patients in the US, with an average of 161/94 millimeter of mercury, had lower initial blood pressure level as compared to an average of 167 to 173/96 to 99 for patients in Europe. The blood pressure levels after treatment were also lower in the US than in any other country – the US had an average of 134/79 millimeters of mercury as compared to 139 to 144/80 to 84 millimeters of mercury in Europe.

Patients in the US also ranked higher in initial pre-treatment blood pressure level with only 65% recording level of 160/100 millimeters of mercury or higher as compared to 81% to 90% of European patients.

“The rate of hypertension control (latest blood pressure level, 140/90 millimeters of mercury or lower) is highest in the US (63 percent vs. 31 percent to 46 percent of patients across European countries),” the study authors said. “In addition, of the 11,969 patients with inadequately controlled hypertension, the US had the highest percentage of patients receiving any medication increase during visit to their doctor (38 percent vs. 15 percent to 28 percent across European countries).”

The researchers also found that use of thiazide medications was almost the same across the nations studied (29% to 31%) but use of other classes of medications varied widely. The US again came first in the use of combination drug therapy with 64% patients receiving it as compared to between 44% and 59% in Europe.

“Together, our findings suggest that better hypertension control in the United States may be explained by lower treatment thresholds and more intensive treatment, both of which are consistent with the more aggressive treatment guidelines in the United States compared with the other countries examined,” the authors concluded.

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