High Blood Pressure Has Become a Neglected Disease

By Capt. Joseph McQuade, Naval Hospital Jacksonville, Fla., Public Health Director

Whenever I see a patient in clinic I always look at their blood pressure. Hypertension, or high blood pressure, causes one in six deaths among American adults — a rate that rose 25 percent over the past decade — and now represents the largest single risk factor for cardiovascular mortality. Former president Franklin Roosevelt died at the early age of 62 from uncontrolled high blood pressure. That fact that so many Americans are at grave risk from not controlling their blood pressure should cause everyone to pause for a moment and consider how well their blood pressure is controlled.

Why do providers always check and recheck the blood pressure when we come in to see them?

High blood pressure has become a “neglected” disease, not given the attention it deserves despite the simplicity of diagnosis, treatment, and prevention on a patient-by-patient basis. Simply stated we use too much salt. That is the opinion of a group of scientists working with the Institute of Medicine.

A priority should be population-level reductions in salt intake, which will call for involvement by government and institutions at the state and local level as well as in Washington, they said.

“Every jurisdiction should immediately begin to consider developing a portfolio of strategies aimed at reducing dietary sodium intake in their population,” they wrote.

Their report also called for other changes in the health environment as keys to population-based success:

• Increased potassium intake (only 2 percent of adults get the recommended 4.7 g per day). Watermelon, cantaloupe and bananas are all good sources of potassium.

• Greater physician adherence to hypertension screening and treatment guidelines. Ask your doctor if your blood pressure is well controlled. Get it down less than 130/80!

• Leveraging community health worker programs to include hypertension prevention and control. People need to understand the benefits of walking every night and getting rid of their salt shakers.

• Reducing the cost of antihypertensive medications to increase adherence to treatment by working with the private sector.

• Greater funding for population-based efforts and interventions. The need for everyone to know about salt reduction, weight control and exercise is an important step to take.

One study projected that cutting back on daily salt intake by three grams (roughly 30 percent), would prevent tens of thousands of strokes and heart attacks each year, while even a one gram reduction would be more cost-effective than treatment with the least expensive blood pressure medication.

Nearly 90 percent of Americans get more than the recommended 2.4 g of sodium per day (the equivalent of six g of salt), the report noted.

Part of the problem is that “the large majority of sodium in the U.S. food supply is added in processing and manufacturing of foods, and a large and increasing amount is used in the fast food industry.”

So watch out for the extra salt. It may be the biggest villain driving your blood pressure up!