The pressure s on to lower hypertension s deadly toll

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Here are some statistics that might give you a reality check: Nearly one in three Americans over the age of 20 have high blood pressure. That means that about 74.5 million people in this country are hypertensive. In addition, the ailment leads to 300,000 annual deaths in the U.S. and is a precursor to heart attacks, strokes, congestive heart failure, and kidney failure, according to the American Heart Association.

But the news is not all bad. About 80 percent of the more than 600,000 patients under Kaiser Permanente’s northern California health plan who have been diagnosed with high blood pressure have the condition under control. This is a marked improvement from a decade ago, when only 44 percent of patients could make that claim. In addition, 70 percent of almost half a million patients in the South Carolina-based quality-improvement network lowered their blood pressure to medically recommended levels, compared to only 49 percent in 2000. These results were presented at the meeting of the American Society for Hypertension last week, which follow similar findings from a major study published last year in the Journal of the American Medical Association; that study showed that half of Americans had their blood pressure under control in 2008, versus 31 percent at the onset of the last decade and 27 percent in the early 1990s.

The study attributed these achievements to an intense focus on adjusting seemingly minor clinical strategies, such as starting patients on a single pill that combines two blood pressure drugs, which ACSH's Dr. Gilbert Ross points out, “should increase drug compliance while simultaneously reducing cost to the patient.”

Currently, a normal blood pressure reading is considered to be 120/80 millimeters of mercury (mm Hg) or lower, though when Dr. Ross was in practice, 140/90 mm Hg, which is now defined as high blood pressure, was actually considered adequate control. “The standard for a normal blood pressure reading has gradually decreased over the years,” he observes, “and I am sure that this more aggressive approach has contributed greatly to the decline in the incidence of cardiovascular diseases over the past 40 years.”

According to the CDC, an additional 28 percent of Americans are considered prehypertensive, meaning their reading falls between 120/80 and 140/90 mm Hg.

The causes of high blood pressure remain unknown for many patients, but it is associated with aging, family history, high salt diets, obesity, sedentary behavior, stress, smoking, and heavy alcohol consumption. Though it affects men and women equally, African Americans have the highest rate of high blood pressure globally.

“In addition to smoking and elevated lipid levels, high blood pressure is the most important condition that we can and should tackle with regard to diagnosis and treatment," says Dr. Ross. “After all, it affects over half the U.S. population.”