Results of a survey conducted by
Harris Interactive(R) for the Hypertension Education Foundation (HEF) were
presented at the American Society of Hypertension, Inc. (ASH) Twenty-Second
Annual Scientific Meeting and Exposition (ASH 2007) in Chicago and
published in the May issue of The Journal of Clinical Hypertension. The
survey suggests encouraging progress in controlling hypertension, also
known as high blood pressure (HBP). There remains a disconnect, however,
between knowledge of what should be done, such as following physician
recommendations about treatment and lifestyle management, and the actions
American adults are taking to manage HBP and the risk factors associated
with it.
"Effective management of hypertension and the decrease in strokes and
cardiovascular events provide a dramatic example of successful disease
prevention," says Dr. Marvin Moser, president of the HEF. "Results of this
survey indicate that nine out of ten people that have been diagnosed with
high blood pressure are on some medication to control it. This is
encouraging, but we have a long way to go since blood pressure is not
controlled at goal levels in many of them. Our findings highlight several
points, including the following: misconceptions regarding high blood
pressure, the need for better patient communication, and evidence
indicating that many adult Americans have not altered their lifestyle to
help prevent the complications of hypertension."
Nearly 60 million American adults have HBP; it has been estimated that
about one-third of them do not know they have the condition because it is
associated with few symptoms. High blood pressure is a primary or
contributing cause of death for over 250,000 people in the US annually and
it is the most common reason that adults see physicians, according to a
2004 report by the U.S. Department of Health and Human Services, National
Institutes of Health and National Heart, Lung and, Blood Institute. It is a
significant risk factor for coronary heart disease, stroke, and heart and
kidney failure. When combined with other conditions, such as an elevated
cholesterol level or diabetes, HBP significantly increases chances of a
cardiovascular event. The good news, Dr. Moser notes, is that lowering
blood pressure (BP) over time will result in decreases of between 35 and
50% in these complications.
The not so good news, according to the survey findings, is that at
least one-third (36%) of patients taking medication had BPs higher than
140/90 mm Hg (the present goal for the general public), the last time they
had it checked. (An additional 14% were not sure what their BP was the last
time they had it checked.) Although this percentage is considerably lower
than in previous surveys, half of the respondents (50%) report that they
were told by their physician that their blood pressure was too high at some
point since they began taking medication. These results cannot be directly
compared to previous surveys since they represent respondents' answers and
not the results of patient examinations. Approximately one-third (31%) of
those who were told that their BP was still too high after they began to
take medication were told by their healthcare provider to keep taking the
same medication. This finding is consistent with other studies.
The survey, which was supported by a grant from King Pharmaceuticals,
Inc., polled 1,245 adults age 45+ who have been diagnosed with HBP. The
survey suggests that most people with HBP understand the risks associated
with it and recognize what they might have to do to help control it. At
least nine out of ten (91%) people surveyed are aware that losing excess
weight and regularly exercising help control hypertension and more than 90%
of survey respondents (correctly) associate HBP with an increased risk of
heart attack (94%) and stroke (93%). In addition, many survey respondents
are aware that HBP increases the risk of other life-threatening conditions
such as failure of the kidney to function properly (61%), hardening of the
arteries (65%) or enlarged heart (61%). This degree of awareness of the
risks associated with hypertension is considerably higher than it was
several years ago.
"Most Americans have become more aware of hypertension and its risks,"
notes Dr. Moser, who is a Clinical Professor of Medicine at Yale University
School of Medicine and Editor-in-Chief of The Journal of Clinical
Hypertension. "Knowing about risks is important, but controlling them may
be difficult because there are few compelling or immediate incentives to
take medication or change habits because of the lack of annoying symptoms
from high blood pressure."
Responses to the survey indicate that general practitioners are the
primary source of information for nearly two out of three respondents
(65%), and that 91% of people diagnosed with HBP were prescribed medication
to manage the disease. While the majority of respondents (56%) are aware of
their treatment goal, and over half received educational materials
explaining the risks associated with HBP from their healthcare provider,
the significant percentage that were unaware of their treatment goals or
did not receive educational materials (42%) indicates a need for better
communication. Additionally, more than a third (36%) of respondents were
not told, or were not sure if they were told, by their healthcare provider
of the cardiovascular risks that might be associated with high blood
pressure.
"The kind of information the patient receives from a doctor can affect
a patient's ability to control his/her high blood pressure," notes Dr.
Moser. "While it is not possible to tell from the survey whether the
communication gap is a problem with the patient or the physician, what is
clear is that some important messages about high blood pressure are not
getting through to enough patients."
Misperceptions Persist
The survey reveals the prevalence of some ongoing misunderstandings
about hypertension, and highlights that some misperceptions were more
prevalent in certain ethnic groups than others. For example, nearly a
quarter (22%) of African-American survey respondents held the belief that
HBP means that a person is tense or anxious, compared to only 10% of
Caucasian and 17% of Hispanic respondents. In addition, African-Americans
were also more likely than Hispanics or Caucasians to believe that
hypertension is less of a problem among older adults.
Other misperceptions cut across all demographic groups. For example,
25% of survey respondents incorrectly believe weight loss alone is enough
to cure HBP/hypertension. In fact, although this was in general a
widely-held misperception, the HEF survey showed that it is a more commonly
held perception among people with incomes of $75,000 or more (31%).
"Misperceptions indicate the need for more education," observes Dr.
Moser. "People's understanding -- or misunderstandings -- about high blood
pressure are key factors in what they do or do not do to try to manage it.
It is, therefore, important that a patient's knowledge base be as accurate
as possible."
Lifestyle Choices Reflect Lack of "Actionable Concern" for HBP Risk
While the survey suggests that many respondents understand that certain
lifestyle adjustments need to be made to help control HBP, a majority of
patients indicate that they are not complying with important lifestyle
management issues such as diet and exercise.
Though nearly all (91%) respondents agree that losing excess weight and
doing regular exercise helps control HBP, only 42% report actually
exercising regularly. In addition, over a third of respondents report that
they do not follow a healthy diet (38%) or limit salt intake (38%). Many
respondents cite that simply taking medication eliminates the need to
manage such lifestyle factors.
"It appears that there is enough concern among individuals diagnosed
with high blood pressure to visit their doctor routinely and take their
medicine, but not enough concern to motivate them to change his/her daily
activities to optimally control their blood pressure," says Dr. Moser.
"Although there is evidence of a higher percentage of control than has been
reported in other national and local surveys, the survey findings here
highlight that there is still a need for improvement, both on the part of
patients and providers of health care."
Methodology
This survey was conducted online within the United States by Harris
Interactive on behalf of the Hypertension Education Foundation and King
Pharmaceuticals, Inc. between January 4 and 17, 2007 among 1,245 adults,
aged 45 and over, who have been diagnosed with hypertension. Figures for
education, age, sex, race/ethnicity, region and household income were
weighted where necessary to bring them into line with their actual
proportions in the population. Propensity score weighting was also used to
adjust for respondents' propensity to be online.
With a pure probability sample of 1,245 adults, one could say with a
ninety-five percent probability that the overall results have a sampling
error of +/- 3 percentage points. Sampling error for data based on
sub-samples would be higher and would vary. However, that does not take
other sources of error into account. This online survey is not based on a
probability sample and therefore no theoretical sampling error can be
calculated.
About HEF
The Hypertension Education Foundation, Inc. (HEF) was incorporated as a
public foundation in 1977 for the purpose of increasing both physician and
public awareness of the problems of treating HBP and promoting research and
teaching efforts in the field of hypertension. It has organized and
participated in more than 50 hypertension symposia throughout the US over
the past eight years and has sponsored Visiting Lecturers, Fellowships in
hypertension, and other educational programs, as well as research into the
causes of hypertension in different ethnic groups. The HEF distributes two
educational booklets, "High Blood Pressure: What You Should Know About It
and What You Can Do To Help Your Doctor Treat It" and "High Blood Pressure
and Diabetes: Control Them and Live Longer." These, as well as other
patient education materials, can be downloaded from the HEF Web site,
hypertensionfoundation.
About Harris Interactive
Harris Interactive is the 12th largest and fastest-growing market
research firm in the world. The company provides innovative research,
insights and strategic advice to help its clients make more confident
decisions which lead to measurable and enduring improvements in
performance. Harris Interactive is widely known for The Harris Poll, one of
the longest running, independent opinion polls, and for pioneering online
market research methods. The company has built what it believes to be the
world's largest panel of survey respondents, the Harris Poll Online. Harris
Interactive serves clients worldwide through its United States, Europe and
Asia offices, its wholly-owned subsidiary Novatris in France, and through a
global network of independent market research firms. The service bureau,
HISB, provides its market research industry clients with mixed-mode data
collection, panel development services, and syndicated and tracking
research consultation. More information about Harris Interactive may be
obtained at harrisinteractive.
Hypertension Education Foundation
hypertensionfoundation