WASHINGTON -- 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; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Information on the study can also be found at HTTP://WWW.IOM.EDU/REDUCEHYPERTENSION. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
[ This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG ]
INSTITUTE OF MEDICINE
Board on Population Health and Public Health Practice
COMMITTEE ON PUBLIC HEALTH PRIORITIES TO REDUCE AND CONTROL HYPERTENSION IN THE U.S. POPULATION
DAVID W. FLEMING, M.D. (CHAIR FROM MARCH 2009)
Director and Health Officer
Public Health - Seattle & King County
Seattle
HOWARD K. KOH, M.D., M.P.H. (CHAIR, JANUARY-MARCH 2009)
Professor of the Practice of Public Health
Department of Health Policy and Management
Harvard School of Public Health
Boston
ANA DIEZ ROUX, M.D., PH.D.
Professor of Epidemiology, and
Director
Center for Social Epidemiology and Population Health
School of Public Health
University of Michigan
Ann Arbor
CORINNE HUSTEN, M.P.H., M.D. *
Former Executive Vice President for Program and Policy
Partnership for Prevention
Washington, D.C.
SHERMAN A. JAMES, PH.D.
Susan B. King Professor of Public Policy Studies,
Professor of Family and Community Medicine, and
Professor of Sociology and African and African-American Studies
Duke University
Durham, N.C.
THOMAS G. PICKERING, M.D., D.PHIL. +
Director of Behavioral Cardiovascular Health and Hypertension
Program
Department of Medicine
College of Physicians and Surgeons
Columbia University
New York City
GEOFFREY ROSENTHAL, PH.D., M.D.
Pediatric Cardiologist
Department of Pediatrics
Cleveland Clinic Foundation
Cleveland
WALTER WILLETT, M.D., DR.P.H.
Fredrick John Stare Professor of Epidemiology and Nutrition and Chair
Department of Nutrition and Epidemiology
Harvard School of Public Health
Boston
INSTITUTE STAFF
ROSE MARIE MARTINEZ, SC.D.
Study Director
* After completion of the committee's work to develop the report, she joined the U.S. Food and Drug Administration as Senior Medical Advisor, Center for Tobacco Products, in October 2009.
+ Deceased