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Experts: U.S. Is Neglecting Hypertension

Institute of Medicine Issues Call to Action for Fighting High Blood Pressure

By Matt McMillen
WebMD Health News

Reviewed By Louise Chang, MD

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 underfunded."

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 short shrift.

"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."

SOURCES: David W. Flemming, MD, chairman, Institute of Medicine committee.

Institute of Medicine: "A Population-Based Policy and Systems Change Approach to prevent and Control Hypertension: Report Brief."

Corinne Husten, MPH, MD, committee member, Institute of Medicine.

Robert Ostfeld, MD, Montefiore Medical Center, Bronx, N.Y.

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