Doctors and patients aren't doing anywhere near enough to fight hypertension, a major risk factor for heart disease and stroke, an influential medical panel said Monday.
Many doctors do not even inform their patients that their blood pressure is high, let alone direct them toward lifestyle measures to reduce it, such as eating more fruits and vegetables and less salt, losing some weight and being more active physically.
The incidence of high blood pressure in this country has reached emergency proportions, said Dr. David W. Fleming, the health officer for Seattle & King County in Washington and chairman of an Institute of Medicine panel that released a new report on the problem Monday.
Hypertension "is easy to prevent, simple to diagnose and inexpensive to treat," he said at a news conference. "Yet nearly 1 in 3 Americans have hypertension and 1 in 6 deaths are caused by hypertension."
Blood pressure is considered high if it is consistently above 140 over 90.
The prevalence of hypertension has increased by 25% in the last decade, and with the aging of the population, the number of people with hypertension has increased to 73 million. It is the second-leading preventable cause of death in this country, following only smoking, the panel said. It is especially common among African Americans.
"This is a call to arms," said Dr. Lawrence J. Appel of Johns Hopkins University, a spokesman for the American Society of Hypertension who was not one of the authors of the report. The report was commissioned by the Centers for Disease Control and Prevention. Though much of the information in the report is not new, "the CDC needed the report to get the resources to take this problem on," Appel said.
"Only 35% of people with hypertension have it under control," said Dr. Corinne Huston, a panel member who is now at the Food and Drug Administration. "If you live long enough, you are almost guaranteed to get hypertension. But that is not true across the world. The environments we live in have a lot to do with it."
Anyone who has read health stories over the last two decades should be aware of the link between high blood pressure and poor health.
Numerous stories have highlighted the unnecessarily high levels of sodium in processed foods and restaurant food, the infrequency with which Americans get out of their houses and walk about, and the failure of many stores in the inner city to provide the fresh produce that is crucial to a healthy diet.
But there is "an incredible disconnect," Fleming said. "I'm not sure that most Americans would recognize the fact that 1 in 3 have [hypertension]. This is a neglected disease."
That disconnect apparently extends to physicians. Perhaps the most surprising finding in the report is that a large proportion of those with uncontrolled hypertension, particularly among the elderly, are under the care of doctors who are not treating their symptoms. Some don't even tell their patients that they are hypertensive if their blood pressure is not substantially elevated.
That is especially true if it is the systolic pressure -- the upper number in a blood pressure reading, which is measured when the heart is pumping -- that is elevated.
"When I was in medical school a long time ago, we were taught not to treat that" as aggressively, Huston said. The feeling was that the elderly needed that extra boost to get blood around the body. "But data show that's not true."
The panel's prescriptions are straightforward:
Most Americans eat about 50% more salt than is recommended. If they reduced salt intake and ate more vegetables, fruit and lean protein, hypertension prevalence could be reduced by about 22%, saving nearly $17.8 billion in healthcare costs, the panel said. In about two months, the Institute of Medicine will issue a report outlining a strategy to reduce salt consumption.
An initiative to get overweight Americans to lose about 10 pounds each could reduce hypertension prevalence by 7% to 8%, according to the panel. And an exercise program that gets physically inactive people more active could decrease prevalence by 4% to 6%.
Another key initiative would be to persuade insurance companies to reduce co-pays and deductibles for hypertension medications, a barrier to treatment. A report issued Friday showed that more than 25% of new prescriptions are not filled, partly due to cost.