Improving Hypertension Management in England Since 1994: Results from the Health Survey for England 1998

The objective of the study was to compare the prevalence, awareness, treatment and control rates of hypertension in a random sample of English adults (≥16 years old) in 1998 and 1994. The Health Survey for England is an annual cross-sectional survey of a stratified random sample of the English population living in private households. In 1998 13,586 adults saw a nurse (response rate 79%). Complete data on medications used and the mean of the last 2 of 3 sitting BP's taken using the Dinamap 3100 for 11529 respondents were analysed. 19.8% of men and 20.0% of women (mean age 62.5 and 66.2 respectively) were ‘hypertensive’ (SBP ≥160mmHg or DBP ≥95mmHg or on treatment for BP). Awareness, treatment and control levels (<160mmHg/<95mmHg) in 1998 and 1994 are shown. (See Table) In 1998 65% of those on treatment were ‘controlled’, but using a target of <140/90mmHg only 29% were controlled. Awareness, treatment and control rates were higher in men than women and of those on treatment 60%, 33% and 7% were receiving 1, 2 and ≥3 drugs respectively. Among 816 respondents on monotherapy for hypertension diuretics (30%) and β-blockers (27%) were the commonest used drugs with only the use of ACE inhibitors being significantly changed since 1994 (18% vs 12%). Using a threshold ‘definition’ and target of 140/90mmHg, 41% of men and 33% of women were hypertensive of whom 46.2% were aware 31.8% were on treatment and 9.3% were controlled. The prevalence of hypertension has not fallen in England, but levels of awareness, treatment and control have all significantly increased. Further improvements in control rates could be realised by the increased use of more than 1 antihypertensive agent.