Differential control of systolic and diastolic blood pressure - Factors associated with lack of blood pressure control in the community

Data from the Third National Health and Nutrition Examination Survey, phase 2 (1991 to 1994), indicate that among hypertensive individuals in the Unit ed States, 53.6% are treated and only 27.4% are controlled to goal levels. We sought to determine whether poor hypertension control is due to lack of systolic or diastolic blood pressure control, or both. We studied Framingha m Heart Study participants examined between 1990 and 1995 and determined ra tes of control to systolic goal (<140 mm Hg), diastolic goal (<90 mm Hg), o r both (systolic <140 and diastolic <90 mm Hg). Of 1959 hypertensive subjec ts (mean age 66 years, 54% women), 32.7% were controlled to systolic goal, 82.9% were controlled to diastolic goal, and only 29.0% were controlled to both. Among the 1189 subjects who were receiving antihypertensive therapy ( 60.7% of all hypertensive subjects), 49.0% were controlled to systolic goal , 89.7% were controlled to diastolic goal, and only 47.8% were controlled t o both. Thus, poor systolic blood pressure control was overwhelmingly respo nsible for poor rates of overall control to goal. Covariates associated wit h lack of systolic control in treated subjects included older age (OR for a ge 61 to 75 years, 2.43, 95% CI 1.79 to 3.29; OR for age >75 years, 4.33, 9 5% CI 3.10 to 6.09), left ventricular hypertrophy (OR 1.63, 95% CI 1.04 to 2.54), and obesity (OR for body mass index greater than or equal to 30 vers us <25 kg/m(2), 1.49, 95% CI 1.08 to 2.06). In this community-based sample of middle-aged and older subjects, overall rates of hypertension control we re remarkably similar to those in the Third National Health and Nutrition E xamination Survey. Poor blood pressure control was overwhelmingly due to la ck of systolic control, even among treated subjects. Therefore, clinicians and policymakers should place greater emphasis on the achievement of goal s ystolic levels in all hypertensive patients, especially those who are older or obese or have target organ damage.