Public health officials and health care providers need to step up their efforts to reduce Americans' increasing rates of high blood pressure and better treat those with the condition, which triggers more than one-third of heart attacks and almost half of heart failures in the United States each year, says a new report from the Institute of Medicine.
Policies that create environments which support healthier eating, lowered sodium consumption, and increased physical activity offer greater promise of reducing the high hypertension rate than merely educating individuals about the dangers of high blood pressure, said the committee that wrote the report.Roughly three-quarters of Americans recognize the importance of having their blood pressure checked, but this awareness has not translated into sustained reductions in the condition.Nearly one-third of U.S. adults have high blood pressure, and it accounts for about one in six adult deaths annually, a 25 percent increase from 1995 to 2005.
Given that many individuals with high blood pressure have not been diagnosed and the majority of patients with hypertension do not have it under control, the report also calls on public health and medical officials to explore ways to improve health care providers' adherence to treatment guidelines.Multiple studies show that physicians are unlikely to start or intensify treatment for mild to moderate hypertension and that they are less aggressive about treating older patients, who are the most likely to have the condition and benefit from therapy.In addition, public health officials should work with health insurance plans to reduce or eliminate deductibles and co-payments for anti-hypertensive drugs to improve patients' compliance with treatment regimens.
"Although hypertension is relatively easy to prevent, simple to diagnose, and relatively inexpensive to treat, it remains the second leading cause of death among Americans, and as such should rightly be called a neglected disease," said committee chair David Fleming, director and health officer, Public Health -- Seattle/King County, Seattle. "Undiagnosed and uncontrolled cases are occurring at alarming rates, even though many people with hypertension see their doctors regularly.We think health care providers can do better at helping patients control their blood pressure, but what will make the biggest difference is creating environments that help people avoid the condition in the first place through healthy eating and active living."
The committee's review of the science points to heavy weight, inactivity, and unhealthy diets containing too much salt and too little potassium as the major risk factors for high blood pressure.Fortunately, all can be prevented through behavioral changes, but the typical American community and lifestyle make a poor diet and inactivity easier patterns to fall into than healthy eating and active living.
The report calls for the U.S. Centers for Disease Control and Prevention to work with partners in the public and private sectors to promote policies that make it easier for people to engage in regular physical activity, cut calories, and reduce their intake of foods containing high levels of sodium while increasing their exposure and access to produce and other foods containing potassium.
Based on available data, the committee estimated that hypertension prevalence might be reduced by as much as 22 percent if Americans consumed less salt in their diet and ate more vegetables, fruit, and lean protein.A recent study calculated that reducing salt intake from 3,400 milligrams to the currently advised maximum intake level of 2,300 milligrams per day could bring down the number of individuals with high blood pressure by about 11.1 million and result in approximately $17.8 billion in health care cost savings annually. The committee also estimated that an initiative to help overweight and obese Americans each lose 10 pounds could reduce the prevalence of high blood pressure in the overall population by 7 percent to 8 percent. An exercise program that gets physically inactive people more active could decrease prevalence by 4 percent to 6 percent.
Efforts to get health care providers to follow current guidelines for treatment and prevention are also needed, the report says.The committee noted that lack of physician adherence to treatment guidelines for hypertension is a significant reason why many patients are unaware of their condition and do not have it under control.Data show that 86 percent of individuals with uncontrolled hypertension have insurance and visit their doctors.Since it is not clear why providers frequently do not follow the guidelines, CDC officials should research this issue as well as work with accreditation programs to improve providers' adherence to recommended treatment regimens.
Out-of-pocket costs are a significant reason why some hypertensive patients reduce or discontinue their medications, the report notes.CDC should encourage the Medicare and Medicaid programs and private insurers to find ways to eliminate or reduce deductibles and co-payments for anti-hypertensive medications and to work with the pharmaceutical industry to standardize and simplify applications for patient assistance programs that provide reduced-cost or free hypertension medications.
The report was sponsored by the U.S. Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention.Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.A committee roster follows.
Copies of A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension are available from the National Academies Press, on the Internet at http://www.nap.edu. Information on the study can also be found at http://www.iom.edu/reducehypertension.
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