If every third American adult came down with malaria, we would be outraged. The public would demand immediate action to start proper treatment, and monitor the results. Then we would also demand steps to prevent any such a calamity from happening again.
Then why is it that high blood pressure (high BP, or hypertension), which is as serious a public health threat, is treated so casually: by patients, doctors, the government, and the public alike?
I feel well, I must be well!
This is one of the most common reactions of the average person. If your head hurts like crazy, you will call your doctor’s office and scream at the receptionist till you receive an early appointment. Or you would race to the nearest emergency room.
If your stomach felt ready to explode, you wouldn’t tell your spouse, “Honey, I’ll go see the doc next month, promise!”
But with high blood pressure, most people never have any symptoms. Even if the blood pressure is dangerously high. So the patient is lulled into a false sense of security.
The data should scare you!
Every third American adult 20 years or older has high BP. That is close to 80 million adults!
It is worldwide!
Do not feel that you are fine if you are not an American. WHO data from 2012 reveal similar percentages of prevalence of hypertension all over the world. In fact, two-thirds of all the people with high BP live in the developing world.
It kills!
Sufferers may feel fine, but hypertension is deadly.
Around half of all deaths from heart disease and stroke worldwide are caused by high blood pressure.
If you are 50 years old, your life expectancy is likely to be approximately 5 years lower if you have high blood pressure compared to your peers of the same age with normal blood pressure.
You can prevent it
Complications of uncontrolled blood pressure are fairly easy to prevent.
Even a small improvement in blood pressure for a short time can improve cardiovascular outcome substantially.
A 10 mm Hg (millimeters of mercury) lower systolic BP (the top number) is linked to a 50-60% drop in the risk of dying from a stroke. It is also associated with a 40-50% lower risk of dying as a complication of blockages in the heart (coronary artery disease).
Controlling blood pressure adequately also slows the progression of heart failure and kidney failure.
So how are we doing?
The National Health and Nutrition Examination Survey (NHANES) data from 2003-2010 reveal that almost 36 million (35.8) Americans did not have their blood pressure under control.
Of these, 14.1 million did not even know that they had high BP.
However, 5.7 million of these people knew they had hypertension, but were not on medications.
Amazingly, 16 million Americans knew they had high BP, and were on medications, but still did not have their BP under control.
Thirty-six million people!
That is a lot of people!
Treating high blood pressure is not rocket science. Leaving thirty-six million people uncontrolled should not be acceptable.
Are they poor and uninsured?
No.
Nearly 90% of American adults with poorly controlled blood pressure have a usual source of healthcare.
Nearly 90% have health insurance.
Nearly 90% received health care in the previous year.
So clearly we are missing opportunities to improve the outcomes of these people.
What is the root problem?
Everybody blames somebody else. And there may well be enough blame to go around.
There are clearly issues with non-standardization of the way BP is measured in clinics and hospitals. There are also questions about the utility of office versus patient home versus ambulatory measurement of BP, and the prognostic value of each of these.
Patients do not always follow instructions. Physicians do not always follow treatment guidelines. And then there are confusing and often contradictory guidelines issued by different “expert panels.”
How to get better?
We need to rethink our entire approach to treating people with high blood pressure.
Among other measures, innovative health-care delivery models are being looked at. These include team-based care, patient-centered medical homes, and efforts to improve medication adherence.
System-wide strategies
Kaiser Permanente implemented a program in Northern California to improve blood pressure control among its patients by creating a hypertension registry to keep track of patients with high blood pressure and the care they were receiving. They instituted several system-wide protocols to monitor and improve the quality of care of these patients.
The result: In 2001, 44% of their patients had their blood pressure under control, while in 2010, this improved to 87%.
During roughly the same period, death rates from stroke in this group went down by 42%, heart attacks went down by 24%, and the most serious types of heart attacks went down by 62%.
Conclusion
- Controlling blood pressure leads to tremendous benefits.
- The healthcare system is currently doing a very poor job of blood pressure control.
- We will need innovative thinking and reforms to improve this state of affairs.
- It is time to get serious!
Want to read more?
My book “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control” deals with these issues in more detail, and is available here: