Women Are More Likely to Address High Blood Pressure By NICHOLAS BAKALAR OCT. 19, 2017 https://www.nytimes.com/2017/10/19/health/high-blood-pressure.htm

Hypertension is dangerous Hypertension is dangerous. High blood pressure damages the inner lining of the arteries, limits the ability of the heart to pump blood and strains the organ in a way that can lead to heart failure. The condition increases the risk for stroke and vascular dementia, and hypertension is one of the most common causes of kidney failure. It impairs vision by damaging the blood vessels in the eyes. But the disease usually has no symptoms, and of the 29 percent of Americans who have high blood pressure, fewer than half have it under control.

From CDC Report

Over Time

Prevalence unchanged over 20 years The prevalence of hypertension was unchanged from 1999 to 2016, according to a new report from the National Center for Health Statistics. The rate of controlled hypertension — people taking medicine to lower it — increased from 1999 to 2010, but was unchanged through 2016. “We monitor the trends and provide the statistical information,” said the lead author of the report, Cheryl D. Fryar, a statistician with the N.C.H.S. “The policy makers and health care people can make their decisions. This is a guide to the next step.”

Black v. White According to Dr. Peter Muennig, a professor of health policy and management at Columbia University who was not involved in the report, younger men take more risks than women in general. Although men are diagnosed with hypertension at similar rates, they are less likely to take the necessary medication. Rates of hypertension were higher among black men and women than among other races and ethnicities. While non-Hispanic blacks had a prevalence of 40.3 percent, whites had a 27.8 percent rate, the same as that among Hispanics. Prevalence was 25 percent among Asians. Even though there are effective treatments, lowering blood pressure can be challenging. “It’s difficult for people to take medicine every day,” Dr. Muennig said. “And even if they do, it’s hard to control blood pressure — dosages vary, multiple medicines are often necessary, they have unpleasant side effects.”

High Prevalence among Blacks Why? Not sure Theories include higher rates of obesity and diabetes among African-Americans. Researchers have also found that there may be a gene that makes African-Americans much more salt sensitive. In people who have this gene, as little as one extra gram (half a teaspoon) of salt could raise blood pressure as much as 5 mm Hg. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandSymptomsRisks/High-Blood-Pressure-and-African-Americans_UCM_301832_Article.jsp#.WeuoT1tSyUk

Economics of Adherence Benefits Like lots of other things, it’s really a MB, MC story. Drugs are reasonably inexpensive, but must be taken every day. MB MC´ MC If perceived MC are higher … Adherence level ↓ A´ A* Adherence Level

From Health Services Research Cost-Effectiveness In the status quo scenario, recommended care processes cost U.S.$187 per person annually (U.S.$61 for visits, U.S.$126 for medications), hospitalizations for hypertension cost U.S.$213, and the proportion of all subjects attaining treatment goals was 0.51 (Table 4). In the improved care scenario, recommended care cost U.S.$449 (U.S.$177 for visits, U.S.$272 for medications), hospitalizations cost U.S.$122, and the proportion of patients at goal rose to 0.70. Thus, relative to the status quo scenario, improved care cost payers U.S.$170 per person annually, or U.S.$1,696 per person newly attaining treatment goals over 2 years.

Source Health Serv Res. 2011 Aug; 46(4): 1124–1157. doi:  10.1111/j.1475-6773.2010.01239.x PMCID: PMC3165181 Cost Implications of Improving Blood Pressure Management among U.S. Adults Teryl K Nuckols, M.D., M.S.H.S., Julia E Aledort, Ph.D., John Adams, Ph.D., Julie Lai, M.P.H., Myong-Hyun Go, Ph.D., Joan Keesey, Ph.D., and Elizabeth McGlynn, Ph.D.