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An estimated 35.8 million U.S. adults with hypertension have uncontrolled blood pressure levels, even though the vast majority have regular access to healthcare and insurance coverage, the CDC reported Tuesday.

That accounts for slightly more than half of all patients with hypertension (53.5%), according to Amy Valderrama, PhD, of the CDC's Division for Heart Disease and Stroke Prevention, and colleagues.

The authors noted online in Morbidity and Mortality Weekly Report that even modest increases in blood pressure are associated with greater risks of cardiovascular disease and mortality, and that those risks are magnified among patients with uncontrolled blood pressure.

On a conference call with reporters, CDC director Thomas Frieden, MD, MPH, said that hypertension -- which he called public health enemy number two behind tobacco use -- accounts for $131 billion in healthcare costs each year and contributes to about 1,000 deaths a day.

"We have to roll up our sleeves and make blood pressure control a priority every day with every patient at every doctor's visit," he said.

Blood pressure control is a priority of the federal government's Million Hearts initiative, which has the goal of preventing one million hearts attacks and strokes by 2017. Part of the effort calls for increasing the number of people whose hypertension is under control by 10 million.

To that end, Frieden said, the CDC will be launching a new program with the U.S. Surgeon General tomorrow called Team Up Pressure Down. The aim of that initiative is to provide pharmacists the tools needed to help patients manage their blood pressure.

Valderrama and colleagues took a closer look at awareness of and pharmacologic treatment of uncontrolled hypertension by examining data from the National Health and Nutrition Examination Survey for 2003 to 2010.

All estimates were based on 20,811 adult participants who were interviewed and examined during the study period.

Overall, 30.4% had hypertension, defined as an average systolic blood pressure of 140 mm Hg or higher, an average diastolic pressure of 90 mm Hg or higher, or use of antihypertensives.

Of those individuals, 53.5% had uncontrolled levels, defined as pressures exceeding those cutoffs. Rates were highest among those who said they hadn't received any medical care in the preceding year, who did not have a usual source of healthcare, and who didn't have health insurance.

Those with uncontrolled blood pressure, however, overwhelmingly reported having received medical care in the preceding year (87.7%), having a usual source of healthcare (89.4%), and having some type of health insurance (85.2%), indicating potential missed opportunities for blood pressure control, according to the authors.

But despite that access to healthcare, most of the patients with uncontrolled blood pressure were either not aware that they had hypertension at all (39.4%) or were aware of their condition but were not receiving pharmacologic treatment (15.8%).

The rest (44.8%) were aware of their condition and were receiving drug treatment but still had uncontrolled blood pressure.

"Improved hypertension control will require an expanded effort and increased focus on hypertension from patients, healthcare systems, and clinicians," Valderrama and colleagues wrote.

They said that strategies to achieve better control include the use of evidence-based practice guidelines, new healthcare delivery models (including team-based care), patient-centered medical homes, and interventions to increase medication adherence.

From the American Heart Association:

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