CDC Profiles US Cholesterol, BP Control

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Hypertension goes uncontrolled in more than half of US adults with the

disease, although that represents a significant improvement compared with

just six years earlier, while high LDL-cholesterol levels are controlled in

only about a third of cases, yet that's more than twice the rate seen

previously.

So found two analyses [1,2] based on data from 1999–2002 and 2005–2008 in

the *National Health and Nutrition Examination Survey *(NHANES), conducted

by the *Centers for Disease Control and Prevention* (CDC). Survey results

also showed that groups with the lowest control rates for both

cardiovascular risk factors include people without health insurance, those

who didn't receive medical care more than once in a year, and Mexican

Americans.

The analyses were published today in " Vital Signs*,* " a monthly edition of

the CDC's *Morbidity and Mortality Weekly Report*.

The prevalence of hypertension (*>*140/90 mm Hg or current antihypertensive

drug therapy, adjusted for sex, age, race, and socioeconomic status) in the

population didn't change much from the earlier to the later period; it went

from 28.1% to 30.9%. However, the prevalence of antihypertensive therapy

among those with hypertension rose significantly, from 60.3% to 69.9%

(p<0.01), as did the rate of blood-pressure control, which went from 33.2%

to 45.8% (p<0.01).

The groups with the lowest rates of antihypertensive therapy included those

18 to 39 years old (37.4%), those lacking a consistent source of medical

care (19.8%), those receiving medical care less than twice a year (33.8%),

and those lacking health insurance (43.5%).

For blood-pressure-control rates by age, those aged 18 to 39 years had the

lowest (31.4%) and those aged 40 to 64 years the highest (48.4%).

By ethnicity, the control rates were 36.9% for Mexican Americans, 47.7% for

white non-Hispanics, and 42.7% for black non-Hispanics.

The rates were 21.1% and 52.0% for those receiving medical care less than

twice and four or more times, respectively, in the previous year.

Control rates were 29.0% for those without health insurance, 47.2% for those

on *Medicare*, and 47.8% for those with private insurance.

The report notes that almost 90% of people with uncontrolled hypertension

have health insurance. " Better control of blood pressure is needed, not only

through improved access to and use of healthcare, but also through

improvements in medical care delivery systems and patients' adherence to

treatment, increased access to healthful foods, and physical activity. The

development of targeted programs for special groups . . . is warranted. "

The prevalence of high LDL-C (per *National Cholesterol Education Program

Adult Treatment Panel III* guidelines) didn't change significantly from

1999–2002 (34.5%) to 2005–2008 (33.5%). But treatment of high LDL-C rose

from 28.4% in the early period to 48.1% in the latter period.

In 2005–2008, the groups with the lowest treatment rates were those aged 20

to 39 years (10.6%), without a usual source of healthcare (17.7%), receiving

care less than twice the previous year (17.7%), and lacking health insurance

(22.6%).

The highest rates were in those aged at least 65 years or covered by

Medicare (64.4% and 63.4%, respectively) and those receiving care at least

four times the prior year (61.4%).

Among those with high LDL-C, the prevalence of LDL-C control rose from 14.6%

in 1999–2002 to 33.2% 2005–2008.

In the most recent period, the lowest rates of control were in those

receiving medical care less than twice the previous year (11.7%, compared

with 42.6% for those receiving care at least four times); those without

medical insurance (13.5%, compared with 41.8% for those with Medicare

coverage and 33.5% for those with private insurance); and, by ethnicity,

Mexican Americans (20.3%, compared with 35.4% and 26.2% for non-Hispanic

whites and blacks, respectively).

About 83% of those with uncontrolled LDL-C levels in the most recent period

had some form of health coverage, the report notes. " Better control of high

LDL-C cannot be achieved only with increased access to healthcare. Key

elements for control also include improved clinical care and better patient

adherence to treatment. The development of targeted programs for special

groups is warranted. "

The CDC reports on hypertension and high LDL-C both conclude that better

control of the two risk factors is likely to be achieved only through a

comprehensive response from multiple sectors of society, including " federal,

state, and local governments; healthcare providers; employers; nonprofit

organizations; and food, restaurant, and pharmaceutical industries. "

www.medscape.com

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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