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Progress in Chronic Disease Prevention Treatment and Perceived Blood Pressure Control Among Self-Reported Hypertensives -- Behavioral Risk Factor Surveillance System, 1986

Survey data show that awareness, treatment, and control of hypertension have increased dramatically since 1974. In 1974, only 51% of hypertensive persons were aware that their blood pressure was high. Thirty-six percent of these persons were under treatment, and 16% of those being treated had their blood pressure under control (160 mm Hg systolic or 95 mm Hg diastolic). By 1984, 85% were aware of their condition, and 74% were under treatment (1). In 1984, however, the definition of high blood pressure was changed from

160/95 mm Hg to 140/90 mm Hg. Because of this new definition, surveys conducted during 1982-1984 showed that only 24% of hypertensive patients on medication had their blood pressure under control (2).

Because most hypertensive persons have been told that their blood pressure is high, surveys using self-reported blood pressure status have been used to assess awareness, treatment, and perceived control of high blood pressure (3). The Behavioral Risk Factor Surveillance System (BRFSS) (4) provides data on self-reported hypertensives from a probability sample of adults in participating states. In this analysis, state-specific estimates of the prevalence of awareness, treatment, and perceived control of hypertension are provided for the 26 states collecting data in 1986.

Survey respondents were defined as "self-reported hypertensives" if they reported that 1) they had been told they had high blood pressure on two or more occasions, 2) they had antihypertensive medication currently prescribed, or 3) they reported having high blood pressure at the time of the survey. Hypertensives were defined as "under treatment" if they reported that medication was currently prescribed. Those who reported that, as far as they knew, their blood pressure was presently normal or under control were defined as "under control". Prevalence estimates and confidence intervals were rounded to the nearest percent.

Table 1 shows the 1986 state-specific prevalences of self-reported hypertensives, hypertensives under treatment, and hypertensives who perceived their blood pressure to be under control. Among participating states, the median percentage of self-reported hypertensives among the adult population was 18% (range 14%-22%). The median percentage of hypertensives under treatment was 75% (range 67%-87%). Finally, the median percentage of hypertensives who were under treatment and thought their blood pressure was under control was 92% (range 88%-98%). Reported by: BR Powell, Alabama Dept of Public Health. T Hughes, Arizona Dept of Health Svcs. F Capell, California Dept of Health Svcs. R Conn, EdD, District of Columbia Dept of Human Svcs. WW Mahoney, Florida Dept of Health and Rehabilitative Svcs. JD Smith, Georgia Dept of Human Resources. E Tash, Hawaii State Health Dept. JV Patterson, Idaho Dept of Health and Welfare. D Patterson, Illinois Dept of Public Health. S Jain, Indiana State Board of Health. K Bramblett, Kentucky Cabinet for Human Resources. SJ Allison, Massachusetts Dept of Public Health. N Salem, Minnesota Center for Health Statistics. M Van Tuinen, PhD, Missouri Dept of Health. R Moon, Montana Dept of Health and Environmental Sciences. L Pendley, New Mexico Health and Environment Dept. H Bzduch, New York State Dept of Health. C Washington, North Carolina Dept of Human Resources. B Lee, North Dakota State Dept of Health. E Capwell, Ohio Dept of Health. J Cataldo, Rhode Island Dept of Health. FC Wheeler, PhD, South Carolina Dept of Health and Environmental Control. J Fortune, Tennessee Dept of Health and Environment. G Edwards, Utah Dept of Health. LR Anderson, West Virginia Dept of Health. DR Murray, Wisconsin Center for Health Statistics. Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: It is reasonable to ask how comparable the estimates of self-reported hypertension status from the 26 BRFSS states are to estimates of hypertension status from other population-based surveys that use measured blood pressures to estimate the prevalence of hypertension status. To answer this question, the median prevalence of hypertension status from the 26 BRFSS states was compared with estimates from in-person surveys that were sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and conducted during the period 1982-1984 by seven state health departments. The median percentage of 18% for self-reported hypertension in the 1986 BRFSS is comparable to the estimate of approximately 16%* for hypertensives who were aware of their condition in the NHLBI surveys (1). However, because actual measurements cannot be taken in the BRFSS, the prevalence of self-reported hypertension includes persons who may not actually have been hypertensive at the time of the survey. In addition, it does not include hypertensives who were not aware of their condition.

The percentage of self-reported hypertensives who reported being under treatment at the time of the BRFSS (75%) is similar to the percentage of hypertensives under treatment in the NHLBI surveys (74%). In contrast, there was a median of 92% for hypertensives who perceived their blood pressure to be under control in the BRFSS, whereas the NHLBI surveys, based on measured blood pressures, estimated that 24% of treated hypertensives were under control (blood pressure 140/90 mm Hg) (2). The implication is that, when 140/90 mm Hg is used as the definition of high blood pressure, many hypertensives who are under treatment may incorrectly consider their blood pressure to be controlled.

Controlling high blood pressure has proven to be one of the most effective means available for reducing mortality in the adult population (4). However, if persons with hypertension erroneously believe that their high blood pressure is under control, they may be less motivated to adhere to their antihypertensive medications or follow beneficial health practices such as restricting intake of sodium, using alcohol in moderation, or controlling their weight. As a result, their blood pressure may remain uncontrolled.

Differences between perceived and actual control of high blood pressure could be due to any of the following nonclinical reasons: 1) health professionals may not have adopted the new definition of controlled blood pressure, 2) health professionals who have adopted the new definition may not have adequately informed patients of the status of their blood pressure control, 3) treated hypertensives may not remember that their blood pressure was not under control, 4) treated hypertensives may misperceive "under treatment" as meaning "under control", or 5) treated hypertensives may be reluctant to admit that their blood pressure is not under control.

Whatever the explanation for the discrepancy between measured and perceived control, health professionals and patients need to view controlled blood pressure as less than or equal to 140/90 mm Hg. In addition, it is important for health professionals to properly inform patients of the status of their blood pressure. Efforts of the National High Blood Pressure Education Program to get the public to "know their numbers", combined with education regarding the definition of hypertension, will help in achieving the 1990 objective of having 60% of hypertensives controlled at or below 140/90 mm Hg (2).


  1. CDC. Advancements in meeting the 1990 hypertension objectives. MMWR 1987;36:144,149-51.

  2. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, 1986:15-23.

  3. Roccella EJ, Bowler AE, Ames MV, Horan MJ. Hypertension knowledge, attitudes, and behavior: 1985 NHIS findings. Public Health Rep 1986;101:599-606.

  4. CDC. Behavioral risk-factor surveillance in selected states--1985. MMWR 1986;35:441-4. *19% prevalence of hypertension x 85% awareness.

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