A weighty topic: American blood pressure

The pressure is on -- because it's from within. That is, Americans in general need to get better at controlling hypertension because the condition is on the upswing.

In a study published online Monday in the journal Hypertension: Journal of the American Heart Assn., researchers at the National Heart, Lung and Blood Institute established that the percentage of Americans with high blood pressure has risen significantly in the last 10 years. We get one guess as to a key reason: obesity.

Using two sets of data from the National Health and Nutrition Examination Survey (1988-1994 and 1999-2004), the researchers came up with a standardized, age-adjusted figure that showed the percentage of Americans with high blood pressure has increased from 24.4% to 28.9%.

One-fifth to four-fifths of that increase, depending on gender and ethnicity, could be linked to a rise in body mass index, they said. Non-Hispanic women were more likely than other groups to have a rise in hypertension rates.

The study also found, however, that treatment and control of the condition have improved. Treatment of the condition rose from 53.1% to 61.4% among those who have it; control of the condition rose from 26.1% to 35.1%. Those numbers don't exactly warrant a declaration of victory over hypertension, but they're signs of progress. Now if everyone else could follow suit ...

Of course, there's still that matter of the rise in the condition overall.

For more on controlling high blood pressure, go to the American Heart Assn. website. There's even a quiz to test your knowledge of the topic. (Lest you doubt how serious it is, note that uncontrolled high blood pressure can increase the risk of heart attack, stroke and kidney failure.) 

A key component of managing high blood pressure is monitoring the condition -- and that now means doing it yourself, not waiting for that occasional visit with your doctor. Here's a recent Los Angeles Times story, Tracking a silent killer, that explains the importance of home monitoring -- with tips on how to do so effectively.

-- Tami Dennis

Photo credit: John Moore /Getty Images

Comments

[edwin]

I don't know why no one is not talking about the correlation of Sodium intake and hypertension- which I understand is also the main reason for Hypertension.

[sm]

Sodium intake is *not* the main cause of hypertension. Only about 30% of people with high blood pressure are sensitive to sodium.

[healthy libertarian]

another example of how poor personal choices are costing all of us money and health. the acceptance of obesity as an illness rather than a consequence of lifestyle decisions is the greatest medical sham of the latest 20 years. No wonder health care costs keep rising - we're eating our way to poverty!

[alpanp]

Here's what I did about my blood pressure: I was taking 5 pills a day and metformin for type 2 diabetes: Cut out ALL GRAINS, SUGARS, CEREALS, POTATOES, FRUITS caffein - ANTYHING that raises insulin levels. Insulin depletes your magnesium; constricting your blood vessels and raising your blood pressure. It also causes you to retain sodium. I eat only slow burning vegetable carbs with protein and fat (dietary fat is irrelevant). I also use the juice of the nopal cactus 8oz/day to stabilize my glucose and as an appetite suppressant. I am now off all meds completely and my blood pressure is now 130/80 and my fasting glucose is 73. and lost 50 pounds. I am 52 years old.

[dlpf]

True: only about 1/3 of people are sodium sensitive. Obesity is the main factor. But cheer up, under Obama, all those drugs will be cheap - or free! No need to lose weight or make any effort at all. The government and insurance companies will keep you alive.

[Margaret Wilde]

There are many prescription drugs that cause sensitivity to salt. In my case it was the oestrogen in HRT. Some other examples are prescribed steroids like prednisone, prednisolone, cortisone, etc and tricyclic anti-depressants like amitriptiline. These drugs cause sensitivity to salt, fluid retention and weight gain. The severity of the side-effects depends on the dosage and the length of time the drugs are taken, as well as the amount of sodium consumed. By eating less salt, people who are sensitive to salt lose weight (because this reduces the fluid retention) as well as lowering high blood pressure.

There is more information about this on my website. The site does not sell anything and has no banners or sponsors or adverts.

[Dan]

Hypertension Control

Cardiovascular disease, I surmise, is very concerning to both patients and their care givers. Furthermore, this disease is likely a cause of distress for many who seek the best treatment once the disease presents itself. As a result, there are increasingly many treatment options available to delay if not prevent such diseases, yet many health care providers were understandably unclear as to which option is the most effective with these deadly disease states manifested by substandard cardiovascular function.
Potential reassurance was made available with the results of the ALLHAT trial, which were published in the Journal of the American Medical Association in 2002, which was conceptualized and implemented by the National Institute of Health. This trial was the largest study to date addressing, among other variables, those with hypertension. In addition, the ALLHAT trial included over 40,000 subjects over the age of 55 who were evaluated in over 600 clinics during the course of this trial. While Pfizer financially contributed a small portion to support this trial, ALLHAT was conceptualized and implemented by the National Institutes of Health at a cost of around 130 million dollars to determine the best medicinal treatment for the patients that were studied in this trial.
The ALLHAT trial, as a result, was largely if not completely void of bias and commercial interference, as there was no relevant association between the trial investigators and the makers of the drugs studied in the trial. Because of the ideal way in which this trial was conducted and completed, most concur the results of this trial are quite accurate and valid.
ALLHAT actualized a true comparative analysis of various classes of drugs for hypertension, which included calcium channel blockers, ACE inhibitors, Alpha Blockers, and Beta Blockers, and diuretics. The researchers examined the action of these classes of medications on the subjects who possessed cardiovascular disease states, with a focus on hypertension. As the trial was completed with data collected over a 4 year period, the trial concluded that one particular class of medications included in this study proved to be the most advantageous for the subjects as it relates to efficacy and cost for those who require treatment for the disease states studied. Amazingly, this one drug class in this study is in fact nearly as old as the subjects involved in the trial.
ALLHAT results specifically and clearly concluded that thiazide diuretics are, overall, the preferred choice of initial medicinal therapy, as this class of drugs overall proved to be more beneficial in many ways compared with the other classes of drugs in the study, which proved to be not any better or safer than diuretics. Diuretics offered great protection against cardiovascular disease, and proved that diuretics should be the first line drug of choice in such patients..
This class of medication has been available in the United States for well over 50 years, and presently costs about 25 dollars a year, instead of a few dollars a day for many if not most branded medications for CV conditions that were examined in the ALLHAT trial. So this finding, of course, concludes that diuretics, which are far less expensive than the other classes of medications that will be addressed in this article, not only provide equivalent if not superior benefits for cardiovascular disease patients, but provide cost savings as well as determined in this trial. The ALLHAT trial was rare and unique in that it compared diuretics to these other classes of medications directly, which is not done frequently with clinical trials involving branded pharmaceuticals.
The ALLHAT study was the largest study ever performed utilizing this comparative effectiveness protocol. To reiterate, the medications included in this trial that compared various classes of medications for the cardiovascular benefits they may provide included calcium channel blockers, ACE inhibitors, and Alpha Blockers, beta blockers, and, thankfully, thiazide diuretics, as this class also reduced the risk of myocardial infarctions, strokes, and heart failure as well as reducing the blood pressure of the hypertension patients in the trial. Diuretics were superior in comparison with calcium channel blockers and beta blockers with such disease states as strokes and heart failure, for example, as well.
Yet, even though this trial was potentially beneficial for so many who are involved with the treatment of patients with cardiovascular disorders, the acknowledgement of diuretics as being superior never really materialized following the release of the results of the ALLHAT trial by the medical community and their utilization of diuretics based on this trial. Even after the researchers of the ALLHAT trial implemented an ALLHAT dissemination plan from the years 2003 to 2006, at a cost of close to 4 million dollars to educate health care providers about the ALLHAT results, and the significance of the findings, the acknowledgement of the benefits of diuretics continued to be unrecognized by health care providers. And the reasons for this may be many.
Of no great surprise, these results of the ALLHAT study appeared to be of notable concern with those pharmaceutical companies who promote the other classes of medications in the ALLHAT trial. Reportedly, these companies increased their promotional spending in order to blunt the potential effects this trial may have on the usage of their cardiovascular medications that belong to the classes that were involved in the ALLHAT trial. Sampling of their medications to health care providers increased noticeably as well.
Furthermore, drugs combining two medications from different classes of medications for hypertension and other cardiovascular disease states are increasingly preferred by many health care providers for understandable reasons presently- depending on the severity of the cardiovascular disease states that may exist, along with the risk of developing these cardiovascular conditions. It is not unusual, for example, for a branded pharmaceutical company to combine their medication for hypertension with a diuretic for those patients that may have a stage of hypertension that requires simply more than just one drug for reduction of their high blood pressure. Yet diuretics remain the first line choice of treatment based on the results of the ALLHAT trial.
I’m comfortable as a layperson in suggesting that the cardiovascular experts should and in fact obligated to continue to make others aware of the results of the ALLHAT trial, and convince others that diuretics should be the preferred choice of medicinal therapy for the medical conditions illustrated and treated in the ALLHAT trial when they happen to exist in such patients, of which there are many. This would ensure that these patients would receive the proven and ideal treatment to delay the progression, if not the prevention, of these cardiovascular events addressed in this trial. Furthermore, billions of dollars would potentially be saved with greater utilization of diuretics instead of more expensive medications that are of no greater benefit. Unfortunately, it appears what may be one of the most authentic trials conducted has been and continues to be largely disregarded- possibly due to the forces of others whose objectives are of a different nature besides the restoration of the health of others as it relates to the diseases addressed in the ALLHAT trial.

Dan Abshear

[alpanp]

All of that notwithstanding Dan, food is your first medicine. As long as we have an FDA that's compromised by corporate interests they won't protect us. High insulin levels are the primary culprit in cardiovascular disease, type 2 diabetes, and hypertension and there is no pill to lower insulin levels - only diet. Read an artilcle on Dr.Mercola's website written by Ron Rosedale on insulin metabolism, change your diet and throw those horse pills away. I don't miss them myself.