Estimated prevalence of uncontrolled hypertension and multiple cardiovascular risk factors and their associated risk of coronary heart disease in the United States

Benner, Joshua S.; Smith, Timothy W.; Petrilla, Allison A.; Klingman, David; Goel, Sangeeta; Tang, Simon S.K.; Wong, Nathan D.

doi:10.1016/j.jash.2007.07.001

« Previous Next »Journal of the American Society of Hypertension
Volume 2, Issue 1 , Pages 44-53, January 2008

Estimated prevalence of uncontrolled hypertension and multiple cardiovascular risk factors and their associated risk of coronary heart disease in the United States

Joshua S. Benner, PharmD, ScD
- IMS Health, Inc., Arlington, Virginia, USA
- Drs. Benner, Smith, and Klingman are all employees of IMS Health, Inc, a health information services and consulting firm. They have provided consulting services to manufacturers of antihypertensive and lipid-lowering therapies, including Pfizer Inc., Schering-Plough Corporation, and AstraZeneca Pharmaceuticals LP.
- Corresponding author: Joshua S. Benner, PharmD, ScD, Principal, IMS Health, Inc., 300 N. Washington Street, Suite 303, Arlington, Virginia 22046. Tel: 703-286-2868; fax: 703-286-2899.
Timothy W. Smith, BA
- IMS Health, Inc., Arlington, Virginia, USA
- Drs. Benner, Smith, and Klingman are all employees of IMS Health, Inc, a health information services and consulting firm. They have provided consulting services to manufacturers of antihypertensive and lipid-lowering therapies, including Pfizer Inc., Schering-Plough Corporation, and AstraZeneca Pharmaceuticals LP.
Allison A. Petrilla, MPH
- IMS Health, Inc., Arlington, Virginia, USA
- Ms. Petrilla and Ms. Goel are consultants to IMS Health, Inc, and Ms. Petrilla is a former employee of IMS Health, Inc.
David Klingman, PhD
- IMS Health, Inc., Arlington, Virginia, USA
- Drs. Benner, Smith, and Klingman are all employees of IMS Health, Inc, a health information services and consulting firm. They have provided consulting services to manufacturers of antihypertensive and lipid-lowering therapies, including Pfizer Inc., Schering-Plough Corporation, and AstraZeneca Pharmaceuticals LP.
Sangeeta Goel, PharmD
- IMS Health, Inc., Arlington, Virginia, USA
- Ms. Petrilla and Ms. Goel are consultants to IMS Health, Inc, and Ms. Petrilla is a former employee of IMS Health, Inc.
Simon S.K. Tang, MPH
- Pfizer Inc., New York, New York, USA
- Mr. Tang is an employee of, and holds stock options for, Pfizer Inc.
Nathan D. Wong, PhD
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California, USA
- Dr. Wong receives grant support from Pfizer Inc., and Bristol Myers Squibb, and is on the speakers’ bureau for Pfizer Inc., Sanofi-Aventis, and Takeda. The staff of IMS Health were paid consultants to Pfizer Inc., in connection with the development of this article.

Received 10 April 2007; accepted 10 July 2007.

Abstract

This study determined the prevalence of primary prevention patients aged 40 to 79 years with uncontrolled hypertension (HTN) and low/moderate cholesterol levels, and the clinical and economic consequences of their cardiovascular risk levels stratified by additional cardiovascular risk factors. Prevalence was estimated from the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) datasets. Framingham risk equations were used to calculate the 4-year risk of coronary heart disease (CHD). HTN and cholesterol levels were then statistically “controlled” to ideal levels and risks were recalculated. Prevalence of uncontrolled hypertension was 15.2 million cases (13.7%). Of those, 12.9 million (84.8%) had low/moderate cholesterol levels, and 2.2 million (16.7%) had ≥3 additional risk factors with no history of CHD. Nearly 200,000 coronary events are expected to occur within 4 years, incurring over $2.5 billion in direct medical costs. Statistical estimation suggests that 64% of 4-year risk was attributable to uncontrolled blood pressure and lipids. The large number and high cost of CHD events expected to occur within the next 4 years in primary prevention patients with uncontrolled hypertension and ≥3 additional risk factors justifies aggressive screening to ensure that these patients are identified and properly managed.

Keywords: Cholesterol, cost, ASCOT-LLA, primary prevention