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PUBLIC INITIATIVES TO IMPROVE THE PREVENTION, DETECTION, AND MANAGEMENT OF HYPERTENSION

  1. Top of page
  2. PUBLIC INITIATIVES TO IMPROVE THE PREVENTION, DETECTION, AND MANAGEMENT OF HYPERTENSION
  3. References

Hypertension, which affects about 60 million adults in the United States, is a major cause of cardiovascular morbidity and mortality, including fatal and nonfatal stroke, myocardial infarction, and heart failure, not only in the United States but worldwide. The American Society of Hypertension (ASH) is the largest organization in the United States that links hypertension and cardiovascular health. Our 22nd Annual Meeting and Exposition in Chicago this year is titled, “Translating Hypertension Research for Cardiovascular Health.” In concordance with our scientific program, ASH leadership is committed to increasing membership of not only physicians but also nurse practitioners, physician assistants, and other health professionals interested in decreasing death and disability related to hypertension. Furthermore, patient-centered educational efforts will be developed and disseminated to accelerate the control rates of hypertension, specifically in the United States.

The good news is that while the prevalence of hypertension has remained somewhat static for the past several years (26.8% in 1999–2000, 29.3% in 2003–2004), there has been significant progress in high blood pressure (BP) control rates.1 In the 1999–2004 National Health and Nutrition Examination Survey (NHANES), encouraging improvements in control rates were seen in both sexes, non-Hispanic blacks, and Mexican Americans.1 Even among patients aged 60 years and older, control rates advanced significantly. Rates of high BP control in non-Hispanic black men improved from 16.3% in 1999 to 2000 to 26.8% and in black women from 24.0% in 1999 to 2000 to 30.3%.1 Although Mexican American men previously had the lowest rates of BP control of all national sex and racial/ethnic groups in the United States, they experienced remarkable advancement from 8.7% in 1999 to 2000 to 31.1% in 2003 to 2004; rates for Mexican American women only increased from 23.4% to 24.6%.1 Recognizing the heterogeneous nature of the US population, the 2007 ASH program continues to emphasize the unique aspects of hypertension in certain racial/ethnic populations. With hypertension in African Americans, there is a focus on the interaction of race, ancestry, and the environment, with efforts to determine the best ways to control the high BP epidemic in this high-risk population.2,3 Regarding hypertension and cardiovascular disease in Asian populations, the global impact and the effects of the cardiometabolic syndrome in Asian Americans must be addressed in an effort to reverse “a tsunami in the making.” Similarly, efforts to focus on hypertension in various Hispanic populations will help define differences in patterns and recognize the impact of adiposity and the cardiometabolic syndrome in Hispanic persons.

Awareness of hypertension has improved remarkably over the past quarter century from 51% from NHANES II (1976–1980) to 76% (2003–2004).1 Pioneering efforts have been seen in New Orleans, Baltimore, and Dallas, utilizing novel approaches to BP evaluation and identification, especially in African Americans, including in barber shops, in beauty shops, in churches, and at sporting events.4 Nevertheless, we must now further translate this awareness into action to continue increasing BP control. Presently, the United States is far from the Healthy People 2010 national goal of 50% control.

Through its scientific and educational efforts for health care professionals, ASH will continue to stimulate basic and clinical research to develop new ways to treat and understand the underlying pathophysiology of hypertension. However, we must also become the voice for the public, including patients and persons with significant family members and friends with hypertension, to better understand the need for lifestyle changes and adherence to medication. ASH leadership and its members are committed to the translation to the public of solid and developing scientific information on hypertension and its effects.

No longer is it adequate for individuals to simply “know their numbers.” New efforts should utilize educational literature and novel technology, such as the Internet, to lead public efforts for patients to “know their risk.” Although it has been historically beneficial for clinicians and researchers to assist the public with hypertension knowledge and awareness, a patient's knowledge of his or her BP does not clearly determine the levels of medication adherence. Indeed, patients with a history of a prior cardiovascular event are less likely to have poor medication adherence than patients who view hypertension as an asymptomatic disease, which they consider divorced from their future survival and functional capacity. Finally, ASH takes the position that identification and control of hypertension is one of the most important interventions that modern clinical medicine can offer to decrease the burden of cardiosvascular death and disability.

References

  1. Top of page
  2. PUBLIC INITIATIVES TO IMPROVE THE PREVENTION, DETECTION, AND MANAGEMENT OF HYPERTENSION
  3. References
  • 1
    Ong KL, Cheung BM, Man YB, et al. Prevalence, awareness, treatment and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49:6975.
  • 2
    National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:25602572.
  • 3
    Douglas JG, Bakris GL, Epstein M, et al, for the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med. 2003;163:525541.
  • 4
    Ferdinand KC. Lessons learned from the Healthy Heart Community Prevention Project in reaching the African American population. J Health Care Poor Underserved. 1997;8:366371.