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Blood pressure reductions 'affected by wealth levels'

Jan 9th 2014 at 8:09 PM

Reduction of high blood pressure is achieved more effectively for wealthier Americans than for those with a poorer socio-economic status, a study from England finds, where the management of hypertension was found to be more equitable.

There was little difference between the countries in overall effectiveness of the management of high blood pressure, or hypertension. To represent high blood pressure, the authors of the research use a reading that consistently reaches 140/90 millimetres or more of mercury (mmHg).

In the US but not in England, "patients on low incomes with high blood pressure have their condition managed poorly compared with those who earn more," say the researchers from Imperial College London. They have published their findings in the online journal PLOS ONE.1

The US Centers for Disease Control and Prevention (CDC) holds current statistics on high blood pressure: it estimates that one in every three adults in the US has hypertension, with the problem being found in the majority of people who present with a stroke, heart attack or heart failure.

It is the leading cause of ill health worldwide, say the Imperial researchers, who wanted to see if there were any differences in the quality of its management between the different health systems of the US and England.

In both systems, the recommended medical management to control blood pressure usually involves doctors suggesting lifestyle changes before prescribing antihypertensive drugs.

Dr. Christopher Millett, from the School of Public Health at Imperial College London and senior author of the study, says:

"Our finding of equitable care for hypertension in England is probably due to the strong primary care system and the negligible cost of care to patients in the NHS, features lacking in the US system."

Using data from national surveys, the study found the level of socioeconomic inequality was "much higher" in the US, with wealthier Americans "more likely to meet targets for bringing their blood pressure under control than poorer patients."
Care differences across age groups and health systems

The study separated out the group aged 65 years or more from those between 50 and 64 years. In the UK, people in both age groups have universal access to primary care services that are free at the point of need, paid for through taxation.
Lady having her blood pressure checked by a doctor
A study has found that wealthier Americans are more likely to achieve reduction in blood pressure compared with those who have a poorer socio-economic status.

In the US, only the over-65s have universal Medicare while the market-based system varies in coverage for the younger age group in the study.

The overall quality of hypertension care for the over-65s was higher in the US than in England, although targets for blood pressure control were only "modestly more likely" to be met. In the younger, over-50s group, however, overall quality of results was similar between the two countries' health systems.

The key difference between the health systems was in the level of care achieved between different people within each age range: in both age groups in the US, wealthier patients were more likely to meet blood pressure targets, whereas there was no disparity based on wealth or income in English patients.

Lead author of the study, Dr. Andrew Dalton, now at the UK's Oxford University, says:

"These findings show that for patients with high blood pressure, the English universal healthcare model provides a similar quality of care to the US market-based system, but does so much more equitably across the population."

Percentage differences

The study results gave percentages for the proportion of people in different groups achieving control of hypertension. In England, there was no significant socio-economic disparity, with a figure of 60.9% for the high-wealth group versus 63.5% for the low-wealth group.

By comparison, the difference in the US within the same 50-64 years age group was marked:

Of the high-wealth citizens, 71.7% achieved target blood pressure control
In the low-wealth group, there was a lower proportion - 55.2% reached target.

Meanwhile, for the greater overall quality of blood pressure results against English counterparts for the Americans aged 65 years and over, the percentages were 58.2% for Medicare, and 53.5% for English NHS care.
Recommended blood pressure targets

The guidelines followed by US doctors for the management of high blood pressure1,2 state that for blood pressures above 115/75 mmHg, every rise of 20/10 mmHg doubles the risk of cardiovascular disease. The lifestyle options they list to help patients treat hypertension are quoted here:

Maintain normal body weight
Adopt a diet rich in fruits, vegetables, and low-fat dairy products
Reduce dietary sodium intake
Take regular aerobic physical activity (eg, brisk walking) at least 30 minutes a day, most days of the week
Moderate your alcohol intake (maximum of 2 drinks a day for men and for 1 drink a day for women and men of lighter weight; a drink having a half ounce alcohol).

The overall hypertension guidelines received an update in December 2013, drawing from the evidence to recommend that anyone aged 60 years or more with hypertension should aim for a blood pressure level of less than 150/90 mmHg.

According to research published in November 2013, over the past 20 to 30 years, there has been a significant decline in cardiovascular disease-related death rates in men but not women - see High blood pressure in women 'more dangerous' than in men.

A review of the evidence across a number of studies, published in September 2013, concluded that exercising in free time may keep blood pressure healthy. The team found that more than 4 hours a week in leisure time was tied to a 19% lower risk of high blood pressure compared with doing less than 1 hour a week of exercise.

Another recent finding: 'Mindfulness training helps lower blood pressure'.

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