Cardiovascular disease (CVD) is the leading cause of death among women in the United States, and hypertension is the most frequent modifiable risk factor. Even though women have greater control of their hypertension than males, control rates have fallen over the last decade. For a study, researchers sought to estimate lost opportunities for hypertension management in premenopausal women with regular access to healthcare in the US population.

They identified US women aged 35-54 years with no past CVD using the National Health and Nutrition Examination Survey (2011-2018). Within the sample, investigators determined the population prevalence of respondents with hypertension (SBP ≥ 140mmHg or DBP ≥ 90mmHg), a regular healthcare provider, at least two visits per year, hypertension awareness (ever been told you have hypertension), hypertension treatment (prescribed and taking hypertension medication), and blood pressure control (SBP < 140mmHg). They calculated hypertension control cascades for this group by comparing 2011-2014 to 2015-2018.

In 2011-2014, 6.4 million women aged 35-54 years with no prior CVD had hypertension, which increased to 8.5 million in 2015-2018. The hypertension control cascade shows the prevalence at each step and missed opportunities to act. In 2015-2018, just two-thirds of this population had regular access to healthcare. The biggest wasted opportunity occurred among women with hypertension under routine care who are unaware of their hypertension (25%), followed by those who are untreated (11%) and uncontrolled (6%). 

The number of premenopausal women with hypertension in the United States grew by 25% from the beginning to the end of the previous decade. Although most of these 2.1 million women are cared for by healthcare professionals, significant gaps in hypertension knowledge, treatment, and management continue and have not improved significantly over the decade. Premenopausal women should prioritize hypertension prevention, access to care, and delivery of guideline-concordant care.