Experts: U.S. Is Neglecting Hypertension
Institute of Medicine Issues Call to Action for Fighting High Blood Pressure
Feb. 22, 2010 -- One out of every three American adults has high blood
pressure, or hypertension. One of every six American adults will die from
complications related to hypertension, such as heart attack, stroke, and kidney failure, making it a
leading cause of death in this country. Yet, according to a new report from the
Institute of Medicine, hypertension is a "neglected disease."
Millions of Americans "develop, live with, and die from hypertension," says
David W. Fleming, MD, chairman of the committee that produced the report. Last
year, hypertension cost the health care system -- directly and indirectly --
more than $73 billion. Yet prevention efforts, Fleming says, are "woefully
The 187-page report released today was commissioned by the CDC, which tasked
the report's authors with identifying the top priorities in its effort to
reduce hypertension nationwide.
Among the most pressing concerns is understanding and addressing why many
doctors fail to adequately treat hypertension in patients whose blood pressure is already in
the unhealthy range. Like prevention efforts, it appears that treatment gets
"We must do better," says Fleming.
The committee is also urging that public health efforts focus on
communities, rather than individuals, as engines of change.
"If you live long enough in this country, you are almost guaranteed to get
hypertension. That's not true across the world," says Corinne Husten, MPH, MD,
senior medical advisor for the FDA's Center for Tobacco Products and member of
the committee that produced the report. "Environment explains why we are so at
risk, and the reality is that unless we create the environment to do the right
thing, we are going to continue to have all these deaths."
Most people, after all, have already gotten the message about eating right
and exercising regularly. The problem,
as the committee sees it, is that too many communities, in particular those in
low-income and minority areas, lack the infrastructure to support healthy
lifestyles, including such basics as safe places to walk and neighborhood
markets that stock fresh produce and low-sodium foods.
Too Much Salt
Regardless of where you live, it's likely that there's too much sodium in
your diet. And that's another major
concern of the committee. Nearly 90% of adults consume more than the
recommended 2,300 milligrams (about a teaspoon) daily limit. For those with
high blood pressure, middle-aged and older adults, and African-Americans, the
daily limit should be even lower (1,500 milligrams).
The salt shaker is not to blame; most of that salt is already in food when
it is purchased, whether it's processed food from a supermarket or a meal eaten
in a restaurant.
While most people get too much salt, the report also emphasizes that those
same people often get too little potassium, another factor in the uptick of
blood pressure levels.
"I'm cautiously optimistic. ...The report has some fantastic ideas," says
Robert Ostfeld, MD, an attending cardiologist at the Montefiore-Einstein Heart
Center in New York who was not associated with the committee. "Getting people
to change their habits is extremely challenging, but healthy habits can be
reinforced by the community, by friends, family, politicians, and hopefully
they will evolve and have substantial benefits."