High blood pressure causing more deaths despite drop in heart disease, stroke deaths

Fewer Americans are dying from heart disease and stroke, but deaths caused by high blood pressure are on the rise, according to new statistics from the American Heart Association.

Although cardiovascular disease is still the biggest killer in the U.S., deaths fell by nearly a third from 2001 to 2011—a drop scientists say reflects improvements in preventing and treating heart disease and stroke. Doctors are encouraged that the trend will continue as healthcare systems around the country better implement evidence-based prevention and treatment guidelines from the AHA and the American College of Cardiology.

Concerns are growing, however, over a 13 percent uptick in hypertension-related deaths over that same span. The new statistical report(link opens in new window), “Heart Disease and Stroke Statistics — 2015 Update: A Report From the American Heart Association,” was released Wednesday and is the only source for current prevalence data on cardiovascular health.

“Deaths attributable to cardiovascular diseases have been on the decline in recent decades. Yet in the face of this good news, we have several disturbing observations that we need to pay attention to because we’re at risk of eroding the gains we have made,” said AHA President Elliott Antman, M.D., professor of medicine and associate dean at Harvard Medical School and a senior physician in the cardiovascular division of Brigham and Women’s Hospital in Boston.

High blood pressure is a major risk factor for heart disease and stroke. Although the death rate going up for one while the other is going down may seem contradictory, one reason is that hypertension can directly lead to other deadly conditions such as heart failure or kidney failure if it is not controlled.

Beyond the conditions themselves are other possible explanations.

Patients do not always take their blood pressure medications as prescribed, and even if they do, doctor’s orders sometimes are not enough, said Willie E. Lawrence Jr., M.D., chief of cardiology at Research Medical Center in Kansas City, Missouri, and an AHA volunteer.

“I think people with hypertension are often undertreated,” he said. “It usually takes more than one medication to get blood pressure under control.” Lawrence noted that through awareness campaigns and community-based initiatives like the AHA’s Check. Change. Control program, more people are successfully controlling their blood pressure.

The report found that most cases have been detected—nearly 83 percent. But of the 80 million Americans with high blood pressure, only about half have it under control. “Awareness is not enough. We have to begin to adequately treat hypertension,” Lawrence said, citing the AHA’s 2020 goal to reduce deaths from cardiovascular diseases and stroke by 20 percent. “We can’t get there by treating coronary artery disease alone.” 

Indeed, a mere 10 percent increase in hypertension treatment would prevent about 14,000 deaths every year, the report noted. For most people, the American Heart Association recommends treatment if blood pressure is 140/90 or higher, and research shows that lowering blood pressure by just 5 points reduces the overall risk of death from any cause by 7 percent.

Antman said the rising hypertension death rate also is probably related to factors plaguing many Americans — lack of physical activity, obesity and too much sodium.

Through programs like Empowered to Serve and the newly launched Heart360 mobile app, the AHA is helping Americans implement an action plan for heart-healthy living, Antman said. The concerning statistics, however, show there is still more work to be done, he added.

“The sky isn’t falling,” Antman said. “There are clouds in the sky, and there are things the AHA is doing to chase them away.”