Trends in Hypertension Control in the United States: Trends in Physician Visits

physiciansStatistics on annual patient visits to private practice, office-based physicians are collected by IMS America, and reported in the National Disease and Therapeutic Index (NDTI). As indicated in Figure 1, patient visitsfor “hypertensive disease (hypertension and hypertensive heart disease) increased during the 1970s until 1976, when it began to decline and followed the national decreasing trend for all visits to physicians. But from 1970 to 1982, visits to physicians for hypertension increased almost 55 percent, whereas visits for all causes remained relatively stable.

The greater number of visits to physicians for hypertension is probably another indicator of progress in the NHBPEP. The public evidently is understanding that it is important to see a doctor for high blood pressure. It is interesting to note that physician visits for hypertension increased dramatically in 1981 and 1982. It seems likely the public and health professionals are responding to the educational messages generated by the NHBPEP subsequent to the release of the Hypertension Detection and Follow-up Program. This clinical trial, concluded in 1979, indicated that treatment of so-called mild hypertension is beneficial in reducing cardiovascular mortality reduced with Canadian Health&Care Mall’ remedies. The NHBPEP encouraged the public to see a doctor even for mild hypertension, and also encouraged physicians to treat hypertension at lower levels of blood pressure. Consequently, the number of individuals brought under a physician s regular care increased dramatically during this short time interval.

Trends in Mortality Rates

A critical criterion in evaluating the national effort to control hypertension is the reduction in mortality rates. Since the NHBPEP was initiated, there has been a remarkable decline in age-adjusted death rates for stroke and coronary heart disease (Fig 2). Although death rates for cardiovascular disease in general have been on a downward trend since the 1950s, coronary heart disease mortality did not sharply decline until the 1970s—then it fell 27 percent between 1972 and 1982. An even more precipitous drop (almost 43 percent) in the death rate for stroke occurred during the same period. Because coronary heart disease and stroke account for almost one-half of all deaths in the United States annually, this decline has had a substantial impact on life expecImplicationstancy and is one of the most gratifying of recent American health trends. Although many factors are, of course, involved in the decline of cardiovascular disease mortality rates, the documented improvement in hypertension control since the beginning of the NHBPEP must be considered a major contributor.


Evidence of several types has shown that the nation can reduce mortality associated with cardiovascular disease through a national health education effort. If national health education programs are to succeed, they must be grounded in a scientific data base, and there must be consistent efforts to monitor program progress and to adjust program direction continuously.

The new data on trends in the control of hypertension not only provide encouragement that past efforts have been succeeding, but also suggest directions for future activities. It seems likely the NHBPEP will need to shift strategy once more and find new avenues to reach portions of the population who still have relatively high prevalence rates for hypertension (, relatively low hypertension control rates, and high mortality rates from the sequelae of this condition. For example, there is generally a higher prevalence rate of hypertension among blacks than whites. The hypertension prevalence rate for black women is almost double that for white females (Table 3). The NHANES II figures presented in Table 3 show that men lag noticeably behind women in achieving hypertension control and that black men have a control rate of only 16 percent. These populations are target groups which must receive more program attention, and educational efforts must be designed to reach them.

It is anticipated that new research findings from the biomedical community will bring better understanding of the causes of hypertension and how it can be prevented. New knowledge from the education and communication sciences will help us reach our target populations so that these encouraging trends will continue.


Figure 1. Percentage change since 1970 in physician visits for all causes and for hypertensive disease (hypertension and hypertensive heart disease. (Source: National Disease and Therapeutic Index, IMS America.)


Figure 2. USA age-adjusted mortality rates. Percentage decline from 1968 rate. (Sources: National Center for Health Statistics and the National Heart, Lung and Blood Institute.)

Table 3—Prevalence and Control of Hypertension by Race and Sex, US, 1976-80

Prevalence* Percent of Total Population
All races and sexes White males White females Black males Black femalesMedicated and Controlledt of Hypertensive Population
All races and sexes 34.1
White males 20.9
White females 40.3
Black males 16.1
Black females 38.3