May is designated High Blood Pressure Month and this year marks the 30th anniversary of the National High Blood Pressure Education Program (NHBPEP), an initiative of the National Heart, Lung, and Blood Institute to get Americans to treat and control high blood pressure.
About 50 million Americans age six and older have high blood pressure, defined as systolic blood pressure (top number) of 140 millimeters of mercury (mm Hg) or higher, or diastolic pressure (bottom number) of 90 mm Hg or higher. Twenty years into the program, visits to physicians for high blood pressure had increased nearly 60 percent, whereas visits for all medical causes increased approximately 7 percent. The average systolic blood pressure has fallen more than 10 mm Hg. Deaths from stroke and coronary heart disease have fallen dramatically for men and women, as well as for white and black Americans in the last 30 years.
But, despite these successes, “We need to renew our efforts together to make sure that more people have their blood pressure measured, and their hypertension recognized and treated,” says Daniel W. Jones, M.D., co-author of the editorial and associate dean of the school of medicine and professor of medicine at the University of Mississippi Medical Center, Jackson, Miss. Jones stresses that treatment itself is not the whole answer. He says physicians should make sure the treatment is effective in reducing blood pressures to the goal – the level identified as beneficial for preventing cardiovascular disease. According to American Heart Association statistics, more than 31 percent of people with high blood pressure are unaware they have it. In addition, 26.2 percent of people with high blood pressure are on medication for it, but do not have it under control.
“In the 30th year of the program, the treatment of hypertension is still inadequate and fails to reverse all of the risk for cardiovascular disease,” he says. “Hypertension is still a public health problem that needs a better solution.”
According to the authors, since the creation of NHBPEP, nearly all American adults have had their blood pressure measured, and most do so on a regular basis. In 1972, 16 percent of high blood pressure patients were controlled to the goal at the time of less than 160/95 mm Hg. A recent survey indicates that the control rate for today’s goal of less than140/90 mm Hg is 29 percent.
Treatment to goal is especially critical when one considers the demographics of the aging population and rising trends in obesity and sedentary lifestyles says Jones. A recent analysis predicts that current middle-aged Americans face a 90 percent chance of developing high blood pressure some time during their lives, according to the editorial.
Cardiovascular disease is still the leading cause of death in this country. Current blood pressure goals may not be low enough, especially for people who have diabetes, according to Jones. The current goal for standard blood pressure is 140/90 mm Hg. For people with diabetes the goal is less than 130/85 mm Hg.
“There is increasing evidence that lower numbers are better. In recent years we have recognized that lower pressures are needed in certain groups, particularly those with diabetes. There’s a good chance that the goals will continue to be reduced,” he says.
In addition, the editorial cites that blood pressure control and cardiovascular disease rates are improving among minority ethnic groups in this country. However, these rates are not improving as fast as majority populations. “The gap that has existed for a number of years between majority and minority populations is actually widening, so we need to continue and renew our efforts in special populations,” says Jones.
Dr. Jones’ co-author is John E. Hall, Ph.D.
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