Let’s talk very briefly a little bit about
the epidemiology. In other words, how common
is this disease.
I’ve already told you a third of Americans
are affected by hypertension. How good are
we in the United States at finding these patients?
Well, you can see the percentages here on
the y axis. And you can see a comparison of
two-year periods: 1999-2002 and 2005-2008.
2005-2008 is in the light green.
And you can see we’ve been doing better
but only a little bit better. You can see
still in only about a third of the patients
are we actually making the diagnosis. When
we make the diagnosis, we’re pretty good
on treatment. We’re up to 70%. But even
when we’re treating, we’re still only
getting adequate control in about half of
the patients – about 50%. So we have a long
way to go in the public-health arena to finding
these patients and treating them.
And here you see the prevalence diagram again
and the point made that, in 2005-2008, 31%
of US adults were found to be hypertensive.
So this is a very common public-health problem.
And I hope I’ve made it perfectly clear:
all of the terrible complications that can
occur if hypertension is not treated.
Interestingly enough, compared to the 1999-2002
there was no significant decline in the hypertension
prevalence – that is how much hypertension
was present in the society – although more
patients were being treated as you saw. As
many as 70% were being treated but only about
half were being well controlled. So we still
have a big job in front of us in terms of
Certain groups are particularly poorly controlled
with respect to their hypertension. First
of all young adults, because often they don’t
think they have hypertension. They ignore
it. Number one. Mexican Americans, where there’s
a high incidence of obesity, also have a very
high risk of not being adequately treated.
Patients in the United States who don’t
have health insurance also have an increased
risk of not being treated adequately. This
has been partly helped by the new Obama Health
Care law but there’s still a significant
number of people in the US who don’t have
health insurance and who get very poor health
care. Patients who don’t have a source for
medical care, living out in very remote areas
where it’s not easy for them to get to a
doctor, often have poorly-controlled hypertension.
And there are some individuals who just don’t
like going to the doctor’s and so forth.
Those who have not received medical care in
the last year also stand a chance of having
poorly-controlled hypertension because they’re
not being monitored adequately by their physician.
Approximately 86% of people in the United
States with uncontrolled hypertension report
having some form of health insurance but,
unfortunately, even patients with health insurance
doesn’t guarantee that they’re going to
be achieving blood-pressure control. And this
is again one of the big problems in health
care I know, not only in the United States
but also in Europe. Getting patients to adhere
to their medical programme. Frequently, patients
will start out and, for one reason or another,
they stop their medicines and their blood
pressure consequently is not well controlled.
And this is true about a whole variety of
medicines, including for example the statin
medicines for cholesterol control. Patients
very frequently stop their medicines for reasons,
“Oh I didn’t think I had to take it for
the rest of my life” or “You know, I’m
worried about effects from these drugs”
and so forth. In fact, it’s been shown in
many excellent scientific studies that you
really need to continue to take these drugs
to get the benefit. And when patients stop
them, bad things happen.