Health Insurance, Regular Healthcare Visits Linked To Hypertension Control

Dr. Brent M. Egan MD Adjunct Professor Medical University of South Interview with:
Dr. Brent M. Egan MD
Professor of Medicine
University of South Carolina School of Medicine Greenville
Senior medical director of the Care Coordination Institute
Greenville, South Carolina

Medical Research: What are the main findings of the study?

Dr. Egan: The study was undertaken to determine progress toward the Healthy People 2020 goals of controlling hypertension or high blood pressure in 61.2% of all adults with the condition. What we found is that hypertension control has changed very little from 2007 through 2012. In 2011-2012, an estimated 51.2% of all hypertensive adults were controlled, which is 10% below the 2020 goal.  The analysis indicated that healthcare insurance and at least two healthcare visits yearly were related to both the likelihood that hypertension would be treated and controlled.

Medical Research: What was most surprising about the results?

Dr. Egan: Control of high blood pressure generally requires that individuals are aware of the hypertension and that aware individuals are treated and treated adults are controlled.  All of these measures showed steady progress from 1999-2000 to 2007-2008 with some continuation of the upward trend in 2009-2010.  However, the 2011-2012 data broke the upward trend line and were more similar to the 2007-2008 than the 2009-2010 data for percentage of adults treated and percentage of treated adults controlled.  The findings strongly suggest that new strategies are required to attain the Healthy People 2020 goal for hypertension control.

Medical Research: Medical Research: What should clinicians and patients take away from your report?

Dr. Egan: Among all adults with hypertension, approximately 20% are unaware that they have high blood pressure and approximately 30% are not treated.  Among adults on treatment for high blood pressure approximately 30% are not controlled.

  1.  The single factor that most strongly predicted treatment and control of hypertension was having at least two medical visits yearly.  In other words, a single annual healthcare check-up is generally not sufficient to properly treat and control hypertension.
  2. Healthcare insurance was also positively associated with treatment and control of hypertension.
  3. Individuals who reported taking treatment for high cholesterol and high blood pressure also more likely to have the hypertension controlled than individuals who reported taking medication only for their high blood pressure.  While this does not prove that cholesterol treatment lowers blood pressure, the majority of people with high blood pressure also have high cholesterol.  Treatment of both risk factors reduces risk for heart attack and stroke more than treatment for only one of the risk factors.  And, as an added benefit, blood pressure control also appears to be better.

What recommendations do you have for future research as a result of this study?
Dr. Egan:

  1. Additional research, especially patient-centered research, is needed to find the best ways to engage more adults in regular health care, to understand their health risk factors, and to take an active role in receiving health care and medications, when necessary, to effectively manage risk.
  2. More research is needed to understand how best to engage more adults with high blood pressure in making lifestyle changes and taking medications needed to control their hypertension.
  3. More research is needed to better understand various options for improving blood pressure control without traditional visits to the doctor’s or another clinician’s office, and to determine which of the options are best for certain groups of patients.


Hypertension in the United States 1999-2012: Progress toward Health People 2020 GoalsBrent M. Egan, Jiexiang Li, Florence N. Hutchison, and Keith C. Ferdinand

Circulation. 2014; published online before print October 20 2014, doi:10.1161/CIRCULATIONAHA.114.010676