Nearly one-third of U.S. adults have high blood pressure. But fewer than half of them have it under control, a new report says. The U.S. Centers for Disease Control and Prevention released the report. It was based on a major national health survey. The survey found that 39% who had high blood pressure were not aware of it. About 16% knew they had the problem but were not taking medicine for it. About 45% were getting drug treatment. Overall, 67 million had high blood pressure. This means they measured high on a blood pressure test or were getting treatment for the condition. Nearly 36 million did not have their high blood pressure under control. Nearly 90% of the uncontrolled group had a regular source of health care, had insurance and had been seen by a doctor in the last year. Researchers said this showed missed opportunities to achieve lower blood pressure. The journal Morbidity and Mortality Weekly Report published the study. HealthDay News wrote about it September 4.

By Mary Pickett, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

This week, the U.S. Centers for Disease Control and Prevention shared numbers that show how well we are controlling high blood pressure. As a nation, we aren't looking very good.

About 30% of adults, ages 18 and older, either had high blood pressure or said they were taking medicine to control high blood pressure. This added up to almost 70 million people. And 53% of them did not have their blood pressure numbers in good control.

Why were there so many people with poor control? Among those who had high blood pressure, 39% had not known about it before they had this check. Another 16% knew about it, but they had not started treatment. It is easy to understand how blood pressure could run high in these groups. A third group -- 45% -- had received medicines from their doctors. But they were not yet successful at bringing the numbers down. That group surprised me.

I am a primary care doctor, and controlling blood pressure takes work. But there are really good reasons to work at it, and really good ways to make sure that you succeed.

What Changes Can I Make Now?

First, if you have high blood pressure, get motivated. If you can bring your blood pressure down to an ideal level with treatment, then you can enjoy the following health benefits:

• Your risk of stroke will be reduced by 30% to 50%.
• Your risk of coronary artery disease (causes of angina and heart attack) will be reduced by 20% to 40%.
• Your risk of congestive heart failure will be reduced by 40% to 80%.
• Your risk of early death will be reduced by 10% to 20%.

Second, know your goal.

• For most people with high blood pressure, the goal is pressure lower than 140/90. This means the top number should be lower than 140, the bottom number lower than 90.
• For people with diabetes or with chronic (long-lasting) kidney disease, the goal is pressure lower than 130/80.
• For people who are elderly, a goal that is a bit higher than 140/90 may be best. Your doctor can help you to pick your target.

Third, start troubleshooting. Here's how you can combat some of the major reasons for blood pressure to run high despite treatment efforts:

Take your medicines. One study found that 40% of patients who are given a medicine to treat high blood pressure stop taking it within the first year. If you have side effects, ask your doctor to try a different medicine. Many blood pressure medicines can be taken once a day, and some cost less than others. If you are having difficulty keeping up with your pills or your bills, ask your doctor about ways to make your plan easier.

Eat less salt. An average American eats about 1.5 teaspoons of salt each day. All of us should eat less. Studies show that people who have high blood pressure despite taking 3 or 4 medicines eat 3 times the average amount of salt.

The most helpful way to lower your salt is to cook your own food, starting with basic ingredients. Try out other spices, cinnamon or herbs. Use natural acids for flavor, such as lemon juice, lime juice, vinegars, tomatoes and yogurt.

Reduce your portion size for condiments. Barbecue sauce, ketchup, soy sauce and other sauces are very salty. You probably will enjoy your food just as much if you squirt or dip into half your usual amount.

Make one of your drugs a diuretic. Most drugs for blood pressure have a pretty equal chance of working if they are working alone. But if one drug is not enough for you, experts agree that one of your drugs should be a diuretic. Common diuretics include hydrochlorothiazide and chlorthalidone. Ask your doctor to check your kidney function. If it is below normal, you may need a stronger diuretic in order to get the blood pressure benefits.

Avoid drugs that raise your blood pressure. Some drugs do. They include:

• Ibuprofen and similar drugs
• Decongestants
• Diet pills
• ADHD medicines
• Birth control pills and other estrogens

Alcohol also raises your blood pressure, so be sure to limit your alcohol intake.

Consider whether you might have sleep apnea. This start-and-stop breathing pattern is common in people who snore and people who are overweight. If you have interrupted sleep, ask your doctor about sleep apnea. This can contribute to high blood pressure.

What Can I Expect Looking to the Future?

With all of these tips, you should succeed if you work at your blood pressure control. Frequent doctor visits and reliable pill-taking are tickets to success.

Here is a plug for doctor visits. Researchers studied people with diabetes and high blood pressure. Those who saw their doctors often had much better blood pressure control.

• Most people with high blood pressure who visited with their doctor and went back within four weeks had good blood pressure control within the two weeks after that.
• Those who went more than a month between doctor visits took at least a year to get their blood pressure back to normal.