Hypertension seen as neglected disease

More aggressive screening, improved surveillance and less-expensive medications could reduce the number of U.S. adults with the cardiovascular risk factor, an IOM report says.

By Christine S. Moyer — Posted March 8, 2010

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Hypertension ranks among the nation's leading causes of death, spurred largely by economic barriers to blood pressure medication, excessive sodium intake and inadequate consumption of potassium, a new study says.

The Institute of Medicine report, released Feb. 22, also found that physicians don't always adhere to screening and treatment guidelines. The problem is not physician awareness or agreement with the guidelines but the challenge of preventing and treating hypertension, said internist Vincenza Snow, MD, director of clinical programs and quality of care for the American College of Physicians.

Elderly patients, for example, often choose not to aggressively pursue control of hypertension. Guidelines also do not account for external factors, such as uninsured patients who can't afford medication and patients with comorbidities, she said.

Guidelines call for periodic screening, with initiation of treatment if systolic blood pressure is greater than 140 mmHg or diastolic is greater than 90 mmHg. A lack of aggressive screening, IOM committee members said, results in an alarming number of Americans with undiagnosed or untreated hypertension.

The IOM committee recommended that the Centers for Disease Control and Prevention conduct research to better understand the reasons for this lack of physician adherence to guidelines and develop strategies to improve screening and treatment of hypertension.

The committee also urged public health agencies to focus on population-based hypertension prevention strategies that aim to improve the well-being of entire communities, rather than concentrating solely on educating at-risk individuals.

"The reality is unless we create the environment that allows people to do the right thing and enhance attention to this problem, we're going to continue having all these preventable deaths," said IOM committee member Corinne Husten, MD, MPH, a senior medical adviser for the Food and Drug Administration's Center for Tobacco Products.

Hypertension prevalence

About 73 million Americans -- nearly one in three adults -- have hypertension, which is the single largest risk factor for cardiovascular mortality and accounts for one in six adult deaths, according to the IOM report. Data from the American Heart Assn. found the number of hypertension-related deaths jumped from 38,000 in 1996 to more than 56,000 in 2006.

The IOM panel estimated that consuming less salt and eating more produce and lean protein could cut the country's hypertension rates by 22%. If an initiative is implemented to help overweight and obese patients lose 10 pounds each, rates could lower an additional 7% to 8%.

IOM committee Chair David Fleming, MD, said the figures are proof that hypertension is an easily treatable yet neglected disease that needs to return to the public's attention.

The CDC Division for Heart Disease and Stroke Prevention has been tackling the hypertension problem for the past two years, largely through efforts to reduce sodium levels in packaged and restaurant food, said division director Darwin Labarthe, MD, MPH.

IOM committee members recommend that the CDC, along with state and local public health departments, continue targeting sodium by advocating for and implementing strategies to reduce salt levels in Americans' diets to meet dietary guidelines. Adults should consume no more than 2,300 mg of sodium per day and high-risk groups -- including adults 40 and older, blacks and those with high blood pressure -- should consume less, according to the IOM.

The report calls on the CDC to develop better methods for assessing and tracking foods with high sodium content. Other recommendations include encouraging people to eat potassium-rich foods, strengthening hypertension surveillance and monitoring, implementing interventions that target obesity and physical inactivity, and reducing costs of antihypertensive medications.

"We're not naïve about the challenges in bringing about real change," Dr. Labarthe said.

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External links

"A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension," Institute of Medicine, Feb. 22 (link)

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