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Control of blood pressure in Scotland: the rule of halves
W C Smith1, A J Lee, I K Crombie
1Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, Dundee.
Insights
Hypertension detection and control in Scotland are inadequate. Many adults with high blood pressure remain undiagnosed, untreated, or poorly managed, impacting overall health outcomes.
Area of Science:
- Cardiovascular Health
- Public Health Surveillance
- Epidemiology
Background:
- Hypertension is a significant risk factor for cardiovascular diseases.
- Effective management of hypertension is crucial for public health.
- Previous assessments of hypertension care in Scotland are limited.
Purpose of the Study:
- To audit the detection, treatment, and control of hypertension in adults in Scotland.
- To identify gaps in hypertension management within the Scottish population.
Main Methods:
- A cross-sectional survey utilizing random population sampling.
- Data collected from general practice centers across 22 Scottish districts.
- Involved 5123 men and 5236 women aged 40-59 from the Scottish Heart Health Study.
Main Results:
- Over 50% of men and 46% of women with hypertension had undetected high blood pressure.
- Among those diagnosed, 42% of men and 33% of women were untreated.
- Control rates were unsatisfactory, with 50% of treated men and 40% of treated women not achieving target blood pressure levels.
Conclusions:
- The detection and control of hypertension in Scotland are currently unsatisfactory.
- Inadequate management of hypertension affects the treatment of other conditions like high cholesterol.
- There is a need for improved strategies to enhance hypertension diagnosis and management across Scotland.
Objective:
Audit of detection, treatment, and control of hypertension in adults in Scotland.
Design:
Cross sectional survey with random population sampling.
Setting:
General practice centres in 22 Scottish districts.
Subjects:
5123 Men and 5236 women aged 40-59 in the Scottish heart health study, randomly selected from 22 districts throughout Scotland, of whom 1262 men and 1061 women had hypertension (defined as receiving antihypertensive treatment or with blood pressure above defined cut off points).
Main Outcome Measure:
Hypertension (assessed by standardised recording, questionnaire on diagnosis, and antihypertensive drug treatment) according to criteria of the World Health Organisation (receiving antihypertensive treatment or blood pressure greater than or equal to 160/95 mm Hg, or both) and to modified criteria of the British Hypertension Society.
Results:
In half the men with blood pressure greater than or equal to 160/95 mm Hg hypertension was undetected (670/1262, 53%), in half of those in whom it had been detected it was untreated (250/592, 42%), and in half of those receiving treatment it was not controlled (172/342, 50%). In women the numbers were: 486/1061, 46%; 188/575, 33%; and 155/387, 40% respectively. Assessment of blood pressure according to the British Hypertension Society's recommendations showed an improvement, but in only a quarter of men and 42% of women was hypertension detected and treated satisfactorily (142/561, 215/514 respectively).
Implications:
The detection and control of hypertension in Scotland is unsatisfactory, affecting management of this and other conditions, such as high blood cholesterol concentration, whose measurement is opportunistic and selective and depends on recognition of other risk factors.