Reversing years of improvements, millions of additional Americans now have uncontrolled blood pressure. Here’s why, and some steps to get back on track. 11/02/2020
For decades, it looked like more Americans were starting to get their blood pressure under control. Scientists have studied the problem as far back as the 1960s, and for a long time, it appeared people were living more heart-healthy lifestyles (HHS, 1986). But that trend has started to reverse in recent years.
A new study shows that some 11 percent fewer Americans are adequately managing their blood pressure versus just a few years earlier (Egan et al., 2020). That means millions of people are now at a higher risk for cardiovascular disease and death.
Health experts say there’s a variety of reasons for this troubling trend. Older adults may not be using medications as effectively as they should, while younger adults might be less concerned about their blood pressure. And, scientists say, there are also likely factors we don’t know about at the moment.
The new research was presented in September at the American Heart Association’s Hypertension 2020 Scientific Sessions. The team involved in the study says there’s an urgent need for more research on what’s causing the rise in uncontrolled blood pressure.
"We cannot assume improvement in blood pressure management will continue, even after 35 years of success,” lead study author Brent M. Egan, a researcher at the University of South Carolina’s School of Medicine, said in announcing the research. “High blood pressure is a serious health risk and deserves constant attention to prevent as many heart attacks and strokes as possible."
High blood pressure is dangerous, but it’s also relatively easy to control with healthy lifestyle choices and medication (AMA, 2017). Diet ranks high among these controllable factors. And a diet high in omega-3 fatty acids, like those from wild-caught salmon, has been shown by numerous studies to help keep blood pressure and other cardiovascular indicators at healthy levels (Fish Oil Therapy Could Prevent 70,000 Heart Attacks and Strokes).
Causes of High Blood Pressure
Blood pressure levels above 140/90 are considered “high,” and “hypertension” is what the condition is called when those levels are maintained long-term. Based on recent numbers, more than 100 million Americans — over half the country’s adult population — now has high blood pressure (Benjamin et al., 2018).
The change has happened relatively quickly. Between 1999 and 2000, research showed that just about one-third of Americans were maintaining healthy blood pressure levels. However, by 2009, those numbers had improved to a more respectable 56 percent. Another analysis done from 2013 to 2014 showed a slight dip, but still found that more than half of Americans had their blood pressure under control (Egan et al., 2020).
But in the years since then, it’s become clear that we’re undoing that progress. A study done between 2015 and 2016 showed a six percent drop in the number of people who were controlling their blood pressure. This latest study shows that trend is only accelerating.
More people have cardiovascular disease now, too (Benjamin et al., 2019).
Scientists say uncontrolled blood pressure isn’t an issue just for older Americans, either.
High blood pressure is increasing across all age groups, perhaps for different reasons. According to a 2019 report from the American Heart Association, some 24 million Americans older than age 20 have heart disease, stroke, or heart failure, which are collectively defined as cardiovascular disease. A possible contributor: increases in obesity and diabetes, both of which are risk factors for heart disease.
Among older adults, the biggest recent increase in high blood pressure seems to be due to people not taking their medicine. And 40- to 59-year-olds seem to struggle with a lack of awareness of the problem, as well as a lack of treatment, the study found.
Foods That Help Lower Blood Pressure
Left uncontrolled, high blood pressure can cause heart attacks and strokes, so it’s important to find ways to get it under control. To that end, the American Heart Association and the American Medical Association teamed up to launch an initiative called “Target: BP” that’s designed to help.
One of their goals is to highlight things that experts know can cause high blood pressure. The list shouldn’t come as much of a surprise to anyone with a casual interest in being healthy. It includes smoking, drinking, stress, being overweight, and more, as risk factors for hypertension (AMA, 2017). The list also includes excessive salt consumption, though the role of salt in hypertension has become controversial (Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events, 2014).
Similarly, the broad list of things that can help lower blood pressure seems fairly obvious. The AHA says that exercise, taking prescribed medications, and eating a well-balanced diet all play a key role. But there are some foods that seem especially helpful.
Omega-3s are one of the most studied nutrients for reducing blood pressure. These healthy fats — particularly two called EPA and DHA — come almost exclusively from seafood. And numerous studies have found evidence that they can help keep blood pressure in check. For example, in a meta-analysis of research that reviewed 70 randomized control trials, scientists looked at how eating fish and taking omega-3 supplements benefit blood pressure (Miller et al., 2014).
They found that EPA and DHA were at least as effective as the most common recommended lifestyle changes.
In the most recent study, scientists looked at people with normal blood pressure, as well as people with high blood pressure who weren’t taking medication for it. They found that omega-3s made a big difference for people with high blood pressure, lowering their systolic (the top number in a blood pressure reading) reading by 4.5 on average. That’s roughly the same blood pressure benefit that people got from exercising more.
Even the Food and Drug Administration says there’s evidence. though not conclusive proof, that eating EPA and DHA omega-3 fatty acids can reduce the risk of coronary heart disease. There are also indications that those two fatty acids together can reduce the risk of hypertension. Though despite the studies mentioned above, the FDA has so far maintained that the existing evidence is inconclusive.
Studies over the years have also found other specific foods that can help. Some fruit such as blueberries, strawberries, and bananas appears to reduce blood pressure (Cassidy et al., 2011) (Hedayati et al., 2008). There’s even evidence chocolate helps our hearts (Taubert et al., 2007) (Mastroiacovo et al., 2015).
Unfortunately, Americans now eat less seafood, and get fewer omega-3s, than our ancestors did not long ago. That doesn’t help when it comes to heart health. But there are countless recipes that make it easy to add things like salmon and shellfish into our diets for an omega-3 boost. And if you don’t like seafood, omega-3 supplements appear to deliver the same heart benefits.
So, if you’re thinking about exercising more and drinking less after all these months of pandemic lockdown, consider adding regular seafood to your diet, too. Your heart may thank you.
Brent M Egan, American Medical Association, Greenville, SC; Jiexiang Li, Coll of Charleston, Charleston, SC; Susan E Sutherland, American Medical Association, Greenville, SC; Michael Rakotz, Gregory Wozniak, American Medical Association, Chicago, ILHypertension Control In The U.s. 2009 To 2018: Rapidly Reversing Years Of Progress. Blood Pressure Monitoring, Control and Adherence to Treatment MP07 | Moderated Poster Session 7: Clinical Science, Epidemiology, Therapeutics Presented on Thursday, September 10, 2020 8:45 AM
Health and Human Services, Vital & Health Statistics; Series 11, No. 234 (7/86). Blood Pressure Levels in Persons 18-74 Years of Age in 1976–80, and Trends in Blood Pressure From 1960 to 1980 in the United States. Data From the National Health Survey.
Heart Disease and Stroke Statistics — 2018 Update: A Report From the American Heart Association. Emelia J. Benjamin et al., On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
Heart Disease and Stroke Statistics — 2019 Update: A Report From the American Heart Association. Emelia J. Benjamin et al., On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
American Heart Association Factsheet. Know Your Risk Factors for High Blood Pressure. December 31, 2017. www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer/know-your-risk-factors-for-high-blood-pressure
American Heart Association Facesheet. Changes You Can Make to Manage High Blood Pressure. November 30, 2017. https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure
Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. New England Journal of Medicine. 2019;380(1):11-22. doi:10.1056/nejmoa1812792
Cassidy A, O'Reilly ÉJ, Kay C, Sampson L, Franz M, Forman JP, Curhan G, Rimm EB. Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr. 2011 Feb;93(2):338-47. Epub 2010 Nov 24.
Hedayati S, Minhajuddin A, Moe OW, Huang CL, et al. Dietary Potassium Deficiency Is Independently Associated with Increased Blood Pressure in a Multi-Ethnic Population-Based Cohort. (SA-FC404). Presented Saturday, November 8, 2008 at the American Society of Nephrology (ASN) 41st Annual Meeting and Scientific Exposition in Philadelphia, PA.
Taubert D, Roesen R, Lehmann C, Jung N, Schomig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007 Jul 4;298(1):49-60.
Mastroiacovo D, Kwik-Uribe C, Grassi D, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study--a randomized controlled trial. Am J Clin Nutr. https://pubmed.ncbi.nlm.nih.gov/25733639/ E-published December 24, 2017.
Miller PE, Van Elswyk M, Alexander DD. Long-Chain Omega-3 Fatty Acids Eicosapentaenoic Acid and Docosahexaenoic Acid and Blood Pressure: A Meta-Analysis of Randomized Controlled Trials. Am J Hypertens. 2014 Mar 6.
Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events. (2014). New England Journal of Medicine, 371(13), 1267-1267. doi:10.1056/nejmx140049