TSTI Health and Wellness: High Blood Pressure, Public Health Enemy #2

High Blood Pressure, Public Health Enemy #2

Hypertension is the term used to describe high blood pressure. Approximately 60% of American adults have either pre-hypertension (33%) or hypertension (27%). This translates to more than 125 million adults. The prevalence of pre-hypertension was higher among men than women (40% versus 23%), but the prevalence of hypertension was similar, which may be related to a lower awareness of hypertension among men. The prevalence (percent of the population affected) has been increasing with approximately half of the increase likely to be attributable to our increase in body weight.

Hypertension is one of our most pressing medical conditions, called public health enemy #2 (trailing tobacco use) according to Centers for Disease Control and Prevention (CDC) Director Dr. Thomas Frieden. When left uncontrolled, hypertension is a leading contributor to heart disease, stroke, and chronic kidney disease. The early studies on treatment of hypertension are impressive because the entire study consisted of only 140 study subjects. The data was so compelling that this small study was sufficient to demonstrate the effectiveness of treatment.

What is Blood Pressure?

Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers, expressed as — 120/80 mmHg. One or both of these numbers can be too high.

The top number is your systolic pressure. It is considered:

High if it is140 mmHg or higher most of the time.

Normal if it is below 120 mmHg most of the time.
The bottom number is your diastolic pressure. It is considered:

High if it is 90 mmHg or higher most of the time.

Normal if it is below 80 most of the time.

Pre-hypertension may be considered when your:

Top number (systolic blood pressure) is between 120 and 139 mmHg, most of the time, or the bottom number (diastolic blood pressure) is between 80 and 89 mmHg, most of the time.

If you have pre-hypertension, you are more likely to develop hypertension.

A single blood pressure measurement, or even several readings over a short period of time, may not be enough to gauge the risk of developing heart disease. Many researchers predict a person’s risk for heart disease risk with a single blood pressure reading, but this can lead to incorrect diagnosis and treatment.

Getting Control to Avoid Complications

The age at diagnosis conveys risk or developing complications as well. Researchers in a recent study tracked blood pressure over 14 years beginning at age 41 years in more than 61,500 men and women, most not taking blood pressure medicine. Men who developed hypertension during middle age had a 70% lifetime risk of developing heart disease or stroke, compared with a risk of 35% among men who had lower blood pressure. A similar relationship was shown among women.

“This study has shown that changes in blood pressure early in middle age affects your lifetime risk,” said the lead author, Norrina Allen, an assistant professor of preventative medicine at Northwestern University. “We need to think about hypertension much earlier in life, around age 40 years.”

Despite the impact of healthy lifestyle choices and many medications available, an estimated 35.8 million U.S. adults with hypertension have uncontrolled blood pressure levels. The vast majority have regular access to healthcare and insurance coverage, the CDC reported in September 2012. That accounts for slightly more than half of all patients with hypertension (53.5%), according to Amy Valderrama, Ph.D., 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 heart disease and death, 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 #2 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 called “Team Up Pressure Down.” The aim of this initiative is to provide pharmacists the tools needed to help patients manage their blood pressure.
In the study, despite that nearly all patients had 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.

What Can You Do?

Have your blood pressure checked regularly, at least once annually.

Keep a record of your blood pressure measurements so that your physician can see how your blood pressure tracks over years.

If you have pre-hypertension or hypertension, it is not too late to adopt healthy lifestyle choices, diet and physical activity and exercise, to better control your blood pressure. Get medical advice before starting an exercise program.

If you are on blood pressure medication, consult with a physician or pharmacist if you have problems so that you can adhere to an effective plan.

September 2012,
submitted by Harvey W. Kaufman, M.D., member TSTI

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