Major missed blood pressure control opportunities in premenopausal women

A new report reveals significant gaps in awareness, treatment and control of hypertension among premenopausal women in the United States, with regular access to health care being a key factor.

In a nationally representative sample of women aged 35-54 with no prior cardiovascular disease, the prevalence of hypertension increased by 8% from an estimated 15.2 million women between 2011-2014 to 16.4 million women between 2015-2018 .

In addition, the percentage of women with controlled hypertension fell from 55% to 50% over the two periods, well below the government’s million hearts Target of 70%.

Missed opportunities to control hypertension in these premenopausal women included:

  • 23% lack awareness of their high blood pressure

  • ineffective treatment in 34%

  • lack of access to healthcare at 43%; increasing to 51% in non-Hispanic Black and 56% in Hispanic patients

Notably, an estimated 3.1 million women (45%) were affected by lack of access to health care in 2011-2014 and 3.5 million women (43%) in 2015-2018.

Equally persistent across the two periods was the lack of effective treatment, affecting 2.1 million (31%) vs. 2.8 million (34%) women, and the lack of awareness, affecting 1.6 million (24 %) versus 1.9 million (23%) women were affected.

“There has been no improvement over the past decade and there is evidence of racial/ethnic differences,” study author Susan Hennessy, PhD, said recently Epidemiology, Prevention/Lifestyle & Cardiometabolic Health (EPI|Lifestyle) 2022 Conference sponsored by the American Heart Association.


dr Susan Hennessy

The prevalence of uncontrolled high blood pressure among non-Hispanic whites was 44% lower than in the US population, and most missed opportunities were due to uncontrolled blood pressure (BP), noted Hennessy, a researcher at the University of California San Francisco School of Medicine.

However, the uncontrolled prevalence was 54% in non-Hispanic Black women and 66% in Hispanic women. “In these two subgroups, more than half of missed opportunities occur because these women do not have regular access to health care,” she said.

In women who identified as “other,” which includes non-Hispanic Asian and multiracial populations, the uncontrolled prevalence reached 70%, and the greatest missed opportunity was among those who were untreated.

Raising awareness, empowering women and providing guideline-compliant care will help premenopausal women gain control of their blood pressure, Hennessy said. “But all of this underpins ensuring equal access to health care because if we don’t manage to get women into the system, we have no way of helping them lower their blood pressure.”

She reminded the audience that cardiovascular disease (CVD) is the leading cause of death among women in the United States and that hypertension-mediated CVD risk increases thereafter menopause. Therefore, treating hypertension before this life event is an important element of primary prevention of CVD and should be a priority.

Session moderator Sadiya S. Khan, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois narrated dasherz.org | Medscape Cardiology that the results “should raise concern and concern that hypertension is not only a disease of the elderly but is very common among younger women, particularly around the time of pregnancy.

‘This idea that patients’Know your numbers‘ is really important and we talk a lot about it for high blood pressure, but if you don’t have a doctor, if you don’t have anyone to go to, it’s very difficult to know or understand what your numbers mean,” she said. I think that’s really the main message.”

Speak with dasherz.org | medscape cardiology, Hennessy said there’s no easy solution to the problem, as some women aren’t even in the system while others aren’t treated effectively, but that increasing opportunities to screen for BP would be a start. This could be through community programs, similar to the Barbershop Hypertension study, or by providing BP devices for home monitoring.

“Again, it’s about empowering ourselves to take some level of control, but as a system we need to be able to make it the same for everyone and make sure they have the right gear and the right cuff size.” , she said. “The inequalities stem from the social determinants of health. So if these women are struggling to get food on the table, they won’t be able to afford a blood pressure cuff.”

During a discussion of the results, the audience noted that the National Health and Nutrition Examination Survey (NHANES) data used for the analysis was somewhat outdated. Hennessy also noted that NHANES blood pressure is measured up to three times during a single visit, which differs from clinical practice, and that the responses were self-reported and therefore subject to memory bias.

The sample included 3,343 women ages 35 to 54 with no prior cardiovascular disease, representing an estimated 31.6 million American women. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg or current use of blood pressure medication.

Epidemiology, Prevention/Lifestyle & Cardiometabolic Health (EPI|Lifestyle) 2022 Conference: Summary 069. Presented on March 4, 2022.

The authors and Kahn report no relevant financial relationships.

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