In a surprising reversal of longtime health gains, fewer adult Americans are aware they have high blood pressure, fewer are getting effective therapy, and more are dying as a result, Federal health officials said here today in issuing new treatment guidelines for the ailment, which affects 50 million Americans.
Over the last 25 years, therapies to fight high blood pressure have led to significant declines in deaths from stroke and coronary heart disease. But the latest health statistics show a rise in severe kidney disease and heart failure, a slight rise in the rate of stroke, and a leveling in the death rate for Americans with coronary heart disease. These conditions often occur as complications of longstanding high blood pressure, which is also called hypertension.
The reason for the abrupt reversal is not known, Federal health officials and experts in high blood pressure said at a news conference. But they said contributing factors could be an increase in obesity, growing complacency among doctors and patients about high blood pressure, a large number of patients who stop drug therapy because of unwanted effects like decreased sexual interest and fatigue, and lack of effective communication to the public.
''We are very concerned to see this decline in awareness and control,'' said Dr. Claude Lenfant, the director of the National Heart, Lung, and Blood Institute, a Federal agency in Bethesda, Md. Dr. Lenfant and Dr. Edward J. Roccella, who is in charge of the Government's education program on high blood pressure, said the institute was developing new public announcements and a research program intended to improve compliance with therapy, which generally has to be lifelong.
The institute released data today from a national survey conducted from 1991 through 1994 by the Centers for Disease Control and Prevention showing that 68.4 percent of Americans with high blood pressure were aware they had the ailment, 53.6 percent were being treated for it, and 27.4 percent had it under adequate control. The target blood pressure level is less than 140/90 mm of mercury. All three figures were down from a similar survey conducted from 1988 to 1991, which showed 73 percent were aware, 55 percent were being treated, and 29 percent had their blood pressure adequately controlled.
Officials had expected the positive trend of the last 20 years to continue, and the reversal, though small, is a challenge to the Government's longstanding goal to control high blood pressure in 50 percent of affected Americans by 2000.
Dr. Roccella said that goal was still realistic, that the Government had met eight of its nine objectives in hypertension control in 1990 and that ''we're optimistic about meeting'' the 50 percent goal in 2000. But Dr. Michael H. Alderman, president of the American Society of Hypertension, said, ''We are failing to achieve our national objective in controlling high blood pressure.''
Millions of taxpayer dollars have been spent on controlling high blood pressure, Dr. Alderman said, and ''progress has stopped, and the report did not explore why that happened.'' Dr. Alderman heads the department of preventive medicine at Albert Einstein College of Medicine in the Bronx.
Dr. Alderman, was one of five experts who resigned for various reasons from the group of more than 100 experts who contributed to the report. Dr. Alderman left because he disagreed with the report's discussion of a class of drugs. This section was unrelated to the main conclusions of the report.
The new guidelines are the sixth in a series dating to 1972 from the heart institute. The latest were developed with the cooperation of 38 national professional, public, and voluntary health organizations and 6 other Federal agencies.
Untreated high blood pressure is a major contributor to heart disease, the leading cause of death among Americans, and strokes, the third leading cause of death. Federal officials have credited the earlier reports for helping to reduce the adverse impact of high blood pressure.
Dr. Sheldon G. Sheps, who headed a committee of experts that wrote the report for the institute said that two-thirds of the reduction in deaths from strokes among African American women in recent years and half the reduction in stroke deaths among white women was attributable to improved blood pressure control.
The new guidelines strongly encourage weight loss, exercise and changes in diet to prevent high blood pressure among all people. Such life style changes can work as the only therapy for some people with high blood pressure and an adjunct to other treatments for everyone with high blood pressure.
The guidelines say those with the mildest form of high blood pressure (140 to 149 systolic, or top number, and 90 to 99 diastolic, bottom number) could try changing life style without drug therapy for up to a year under vigilant blood pressure monitoring.
Such changes include weight reduction of at least 10 pounds; 30 to 45 minutes of aerobic activity on most days; intake of no more than a teaspoon of salt a day including that in processed foods; and increased potassium intake. But care must be taken by those with kidney disease because of potential dangers in the potassium intake.
For the first time, the guidelines endorse a specific diet. One rich in fruits, vegetables and low-fat dairy foods, and with reduced saturated and total fats, could significantly lower blood pressure for all Americans, the report said.
For first-line therapy for individuals with uncomplicated high blood pressure, the guidelines recommended drugs from the diuretic and beta-blocker classes. Different types of drugs may be indicated for those with certain conditions like diabetes or heart failure.
A major challenge is to improve adherence to therapy. Without providing specific figures, Dr. Rocella said that ''there are more people who have been in treatment for high blood pressure who have dropped out than who are on therapy.''
Over the last 25 years, therapies to fight high blood pressure have led to significant declines in deaths from stroke and coronary heart disease. But the latest health statistics show a rise in severe kidney disease and heart failure, a slight rise in the rate of stroke, and a leveling in the death rate for Americans with coronary heart disease. These conditions often occur as complications of longstanding high blood pressure, which is also called hypertension.
The reason for the abrupt reversal is not known, Federal health officials and experts in high blood pressure said at a news conference. But they said contributing factors could be an increase in obesity, growing complacency among doctors and patients about high blood pressure, a large number of patients who stop drug therapy because of unwanted effects like decreased sexual interest and fatigue, and lack of effective communication to the public.
''We are very concerned to see this decline in awareness and control,'' said Dr. Claude Lenfant, the director of the National Heart, Lung, and Blood Institute, a Federal agency in Bethesda, Md. Dr. Lenfant and Dr. Edward J. Roccella, who is in charge of the Government's education program on high blood pressure, said the institute was developing new public announcements and a research program intended to improve compliance with therapy, which generally has to be lifelong.
The institute released data today from a national survey conducted from 1991 through 1994 by the Centers for Disease Control and Prevention showing that 68.4 percent of Americans with high blood pressure were aware they had the ailment, 53.6 percent were being treated for it, and 27.4 percent had it under adequate control. The target blood pressure level is less than 140/90 mm of mercury. All three figures were down from a similar survey conducted from 1988 to 1991, which showed 73 percent were aware, 55 percent were being treated, and 29 percent had their blood pressure adequately controlled.
Officials had expected the positive trend of the last 20 years to continue, and the reversal, though small, is a challenge to the Government's longstanding goal to control high blood pressure in 50 percent of affected Americans by 2000.
Dr. Roccella said that goal was still realistic, that the Government had met eight of its nine objectives in hypertension control in 1990 and that ''we're optimistic about meeting'' the 50 percent goal in 2000. But Dr. Michael H. Alderman, president of the American Society of Hypertension, said, ''We are failing to achieve our national objective in controlling high blood pressure.''
Millions of taxpayer dollars have been spent on controlling high blood pressure, Dr. Alderman said, and ''progress has stopped, and the report did not explore why that happened.'' Dr. Alderman heads the department of preventive medicine at Albert Einstein College of Medicine in the Bronx.
Dr. Alderman, was one of five experts who resigned for various reasons from the group of more than 100 experts who contributed to the report. Dr. Alderman left because he disagreed with the report's discussion of a class of drugs. This section was unrelated to the main conclusions of the report.
The new guidelines are the sixth in a series dating to 1972 from the heart institute. The latest were developed with the cooperation of 38 national professional, public, and voluntary health organizations and 6 other Federal agencies.
Untreated high blood pressure is a major contributor to heart disease, the leading cause of death among Americans, and strokes, the third leading cause of death. Federal officials have credited the earlier reports for helping to reduce the adverse impact of high blood pressure.
Dr. Sheldon G. Sheps, who headed a committee of experts that wrote the report for the institute said that two-thirds of the reduction in deaths from strokes among African American women in recent years and half the reduction in stroke deaths among white women was attributable to improved blood pressure control.
The new guidelines strongly encourage weight loss, exercise and changes in diet to prevent high blood pressure among all people. Such life style changes can work as the only therapy for some people with high blood pressure and an adjunct to other treatments for everyone with high blood pressure.
The guidelines say those with the mildest form of high blood pressure (140 to 149 systolic, or top number, and 90 to 99 diastolic, bottom number) could try changing life style without drug therapy for up to a year under vigilant blood pressure monitoring.
Such changes include weight reduction of at least 10 pounds; 30 to 45 minutes of aerobic activity on most days; intake of no more than a teaspoon of salt a day including that in processed foods; and increased potassium intake. But care must be taken by those with kidney disease because of potential dangers in the potassium intake.
For the first time, the guidelines endorse a specific diet. One rich in fruits, vegetables and low-fat dairy foods, and with reduced saturated and total fats, could significantly lower blood pressure for all Americans, the report said.
For first-line therapy for individuals with uncomplicated high blood pressure, the guidelines recommended drugs from the diuretic and beta-blocker classes. Different types of drugs may be indicated for those with certain conditions like diabetes or heart failure.
A major challenge is to improve adherence to therapy. Without providing specific figures, Dr. Rocella said that ''there are more people who have been in treatment for high blood pressure who have dropped out than who are on therapy.''
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