IOM Report Calls for Key Strategies to Reduce High Blood Pressure

A new report released by the Institute of Medicine (IOM) calls high blood pressure a “neglected disease”—and with good reason. High blood pressure poses the single, greatest risk factor for deaths from cardiovascular disease, yet millions of people do not even know they have it. Out of the 73 million American adults who have high blood pressure, 28.2% are unaware that they are living with the disease. In North Carolina, studies show that only one in four adults has been diagnosed with high blood pressure.

According to the report, “A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension,” high blood pressure is the nation’s second leading cause of death and is responsible for about one in six adult deaths annually, a 25.2% increase from 1995 to 2005. The total direct and indirect costs on the health care system are estimated at $73.4 billion in 2009 alone.

High blood pressure is a condition that is generally easy to prevent, simple to diagnose, and inexpensive to treat, but doctors aren’t doing a good job of warning their patients that their blood pressure is high or telling them how to control it. The report calls for the concerted efforts of public health officials and health care providers to carry out broad-range initiatives that help the greatest number of people reduce and manage high blood pressure.

“High blood pressure is a ticking time bomb,” said Ross Simpson, Jr., MD, PhD, MPH, director of the preventive cardiology program and a professor of medicine in the division of cardiology at the University of North Carolina. Dr. Simpson also serves as the principal clinical coordinator for The Carolinas Center for Medical Excellence. “This is a condition that takes a significant toll on your heart and brain. It increases the risk of stroke and a heart attack, and it dramatically increases the risk for kidney failure. Uncontrolled hypertension has a myriad of effects throughout the body.”

Blood pressure is considered high if it is consistently above 140 over 90. “The risk for heart attack and stroke doubles for every 10-point increase in diastolic blood pressure,” Dr Simpson said. “The nice thing about it is if you control your blood pressure and bring it back to normal, you lower your risk for a heart attack.”

As the country’s population continues to age, reducing and preventing high blood pressure is more important than ever. Studies show that Americans have a 90% chance of developing high blood pressure from age 50 and older, but doctors are less aggressive about treating older patients. Improving health care providers’ adherence to current treatment guidelines are among the key recommendations emphasized in the report. The report also focused on making drug therapy more affordable. Public health officials are strongly encouraged to work with health insurance plans to reduce or eliminate deductibles and out-of-pocket costs for antihypertensive drugs to ensure patients continue with their medications and treatments.

The report, commissioned by the U.S. Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, laid out other high-priority recommendations for system-wide improvements. The report emphasized the need for population-based policies that promote healthy behavioral and lifestyle changes, such as reducing salt consumption, promoting the intake of potassium-rich fruits and vegetables, increasing physical activity, and reducing alcohol consumption—all of which play a significant role in raising blood pressure if no action is taken.

Based on data cited in the report, the prevalence of people with high blood pressure could be cut by as much as 22% if people ate less salt in their diet and more vegetables, fruit, and lean protein. This is a savings of nearly $17.8 billion in health care costs, annually. (In about two months, the Institute of Medicine will issue a report outlining a strategy to reduce salt consumption.)

The report also estimates that the prevalence of people with high blood pressure could decrease by 7% to 8% if policy initiatives were put in place to get obese and overweight Americans to lose about 10 pounds each. An exercise program that gets physically inactive people more active could reduce prevalence by 4% to 6%.

“The truth is, though, it’s really more important for people before they have high blood pressure to exercise regularly, eat sensibly, and control their weight,” Dr. Simpson said. “It makes a huge difference in whether they develop high blood pressure. That’s the key.”

For more information about “A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension,” visit www.nap.edu or speak to a Home Care Specialist at Right at Home High Point

Resources:

The Carolinas Center