Blood pressure reductions 'affected by wealth levels'

Reduction of high blood pressure is achieved more effectively for wealthier Americans than for those with a poorer socio-economic status, a study from England finds, where the management of hypertension was found to be more equitable.

There was little difference between the countries in overall effectiveness of the management of high blood pressure, or hypertension. To represent high blood pressure, the authors of the research use a reading that consistently reaches 140/90 millimetres or more of mercury (mmHg).

In the US but not in England, "patients on low incomes with high blood pressure have their condition managed poorly compared with those who earn more," say the researchers from Imperial College London. They have published their findings in the online journal PLOS ONE.¹

The US Centers for Disease Control and Prevention (CDC) holds current statistics on high blood pressure: it estimates that one in every three adults in the US has hypertension, with the problem being found in the majority of people who present with a stroke, heart attack or heart failure.

It is the leading cause of ill health worldwide, say the Imperial researchers, who wanted to see if there were any differences in the quality of its management between the different health systems of the US and England.

In both systems, the recommended medical management to control blood pressure usually involves doctors suggesting lifestyle changes before prescribing antihypertensive drugs.

Dr. Christopher Millett, from the School of Public Health at Imperial College London and senior author of the study, says:

"Our finding of equitable care for hypertension in England is probably due to the strong primary care system and the negligible cost of care to patients in the NHS, features lacking in the US system."

Using data from national surveys, the study found the level of socioeconomic inequality was "much higher" in the US, with wealthier Americans "more likely to meet targets for bringing their blood pressure under control than poorer patients."

Care differences across age groups and health systems

The study separated out the group aged 65 years or more from those between 50 and 64 years. In the UK, people in both age groups have universal access to primary care services that are free at the point of need, paid for through taxation.