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According to a new study, after nearly 15 years of being on an upward trend, awareness among Americans about high blood pressure — and how to control and treat it — is now on the decline. The study, funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, appeared online on Sept. 9 in JAMA. The research found that some groups, including older adults, are less like to adequately control their blood pressure, even with the help of blood pressure medications.

Experts are concerned because the trend could threaten decades of public health work against heart disease.

The authors say the trend could make longstanding efforts to fight heart disease and stroke even more challenging. High blood pressure, also called hypertension, is a significant risk factor for heart disease. According to the Centers for Disease Control and Prevention, nearly 108 million Americans have hypertension and take medication for their blood pressure. Still, only 27 million are considered to have their blood pressure under control, despite it being a condition that can be managed.

Lawrence Fine, M.D., chief of the Clinical Applications and Prevention Branch at NHLBI and a study co-author, said, “Reversing this decline is important because we don’t want to lose public health achievements built over prior decades.” He went on to explain, “It is a challenge for the scientific community to investigate the causes of this unexpected downward trend, but developing more effective strategies to reverse and substantially improve blood pressure control is critical for the health of many Americans.”

At the beginning of the survey, the 18,262 U.S. participants age 18 and older, with high blood pressure, had their blood pressure measured three times, then averaged. They answered “yes” or “no” when asked if their doctors told them they had high blood pressure and if they currently took prescribed medication for high blood pressure.

With data from the National Health and Nutrition Examination Survey (NHANES) taken between1999 and 2018, the study authors looked at 20-year trends in high blood pressure awareness and treatment and blood pressure control. The authors found that in 1999-2000, just 70% of participants showed an awareness of their condition. That number increased to 85% in 2013-2014 but sharply declined to 77% in 2017-2018. Of those “aware” adults, the number who also were taking blood pressure medications remained relatively consistent—85% in 1999-2000, 89% in 2013-2014, and 88% in 2017-2018.

Of all adults with high blood pressure, the number who managed to control their condition increased from 32% in 1999-2000 to 54% in 2013-2014 but then declined to 44% in 2017-2018. Of those with controlled blood pressure, the number taking blood pressure medication increased from 53% in 1999-2000 to 72% in 2013-2014, then declined to 65% in 2017-2018.

“The reversal in hypertension awareness is a real set back in the fight to reduce heart disease and stroke,” said Paul Muntner, Ph.D., the lead study author who also is professor and Associate Dean for Research in the School of Public Health at the University of Alabama at Birmingham.

“While lifestyle factors are big contributors to hypertension, awareness, and appropriate treatment are key to lowering blood pressure and keeping it in a healthy range to greatly reduce the risk for heart disease and stroke.”

There are several practical approaches to combat high blood pressure.

“Educating patients and providers on blood pressure goals, adding effective blood pressure medications when lifestyle changes aren’t enough, and reducing barriers to achieve high medication adherence in a variety of clinical practice settings are just a few strategies that may facilitate increases in blood pressure control rates and reduce health disparities we identified in the current study, added Muntner.”

Even though this particular study’s findings may seem grim, we know that we are in charge of our bodies and health. Eat a healthy diet. Stay active. You know the drill. Just be proactive in your own life. Be disciplined, and stay aware of what’s fueling you.