Tuesday, September 18, 2012

Hypertension: Home and Abroad, Fallacies and Facts



Once again, the New York Times, considered by many from inside and outside America as the de facto newspaper of record among United States news outlets, has been exposed. Expressing outrage about the recent Centers for Disease Control report showing that about half of Americans who are diagnosed with high blood pressure go without treatment, its main editorial on September 8, 2012 sought to single out and directly indict the U.S. health care system as the culprit.

The Times declared that the study “is shocking evidence of how our complicated, dysfunctional health care system can’t deliver recommended care to many patients who could benefit”, and insisted that “the wonder is that the health care system has done such a bad job of delivering those benefits.” Implicit in this harsh critique is the relative superiority of health systems with nationalized insurance, the same systems that are held up as models for reform by our president and many supporters of his health law.
Scott Atlas, MD, “The Liberal Media's Erroneous Indictment Of U.S. Health Care: There They Go Again...”,  Forbes, September 18, 2012,  Scott W. Atlas, M.D., a Senior Fellow at Hoover Institution of Stanford University. He is the author of the recently published book In Excellent Health: Setting the Record Straight on America’s Health Care, (Hoover Press, 2011).
September 18, 2012 -   Once cost considerations are removed, nationalized insurance proponents contend citizens will receive successful treatment for common conditions such as hypertension, a  condition that afflicts 67 million Ameriqans and serves s a coomon precursor  for strokes,  heart attacks , and heart failure. 

This raises three fundamental questions.
One, in what countries will a patient diagnosed with hypertension receive medical treatment?
An international analysis comparing the United States to Canada and five Western European nations noted significant discrepancies between the United States and both Europe and Canada in treating diagnosed hypertension. In one study, treatment of diagnosed high blood pressure (140/90) was highest in the U.S. (53 percent); England had the lowest percent treatment (25 percent), followed by Sweden and Germany (26 percent), Spain (27 percent), Italy (32 percent), and Canada (36 percent).

Drug treatment for already diagnosed high blood pressure was highest in the U.S. of all ten Western European countries studied in 2010, including Austria, Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, and Switzerland.
Fact #1
Patients diagnosed with high blood pressure in the U.S. have a significantly higher chance of actually being treated than in any comparison country, including those with nationalized health insurance 
Two,  in what countries will patients receiving hypertension treatment be successfully treated?
Hypertension treatment has been more successful in the United States than elsewhere in the world. One direct comparison showed that control in treated patients was highest in the United States (54 percent), with Canada (47 percent), England (40 percent), Germany (30 percent), Italy (28 percent), Spain (19 percent), and Sweden (21 percent) all showing worse results for those 35 to 64 years of age.
These differences in hypertension control were all statistically significant, even after accounting for other diseases, concurrent drug treatment, and initial pre-treatment blood pressure levels. Only 10 percent of the fortunate 32 percent of British men and 31 percent of British women reported in 2011 who actually received medical treatment for their known hypertension were treated successfully, leaving a full 90 percent who were treated but “poorly controlled.”
Fact #2 – Patients treated for high blood pressure in the U.S. have a significantly higher chance of being successfully treated than in any comparison country.

Three, Why is high blood pressure more successfully controlled in the United States?
In a detailed 2007 analysis of over 21,000 hypertensive patients already visiting doctors for hypertension in five Western European nations (France, Germany, Italy, Spain, and the United Kingdom) and the United States, the best rate of success was in the United States (63 percent), compared with 31 percent to 46 percent of patients in the European countries. Of the patients with inadequately controlled blood pressure, the U.S. had the highest percentage of patients receiving a medication increase during the visit (38 percent compared with only 15 percent to 28 percent in Europe). The use of combination drug therapy (two or more drugs) was also highest in the U.S. (64 percent compared with 44 percent to 59 percent in the European countries).
After treatment, the latest blood pressure levels were, not surprisingly, lowest in the U.S. The bottom line conclusion by the authors was that “lower treatment thresholds and more intensive treatment contribute to better hypertension control in the United States”, matching the conclusion by a 2010 comparison that “quite clearly, the United States has the most diagnosed high blood pressure but also the fewest people with measured high levels because of the aggressive use of drugs.”
Fact #3 – The delivery of medical care for high blood pressure is best in the United States.
Tweet:  Patients with high BP in U.S. are more often treated  and treated successfuly than in countries with nationalized insurance.