The Moment of Truth on Hypertension

By Balatbat, Joseph H. | Journal of Continuing Education Topics & Issues, August 2008 | Go to article overview

The Moment of Truth on Hypertension


Balatbat, Joseph H., Journal of Continuing Education Topics & Issues


At least 122 million Americans are overweight or obese. (1) Mean sodium intake is approximately 4,100 mg per day for men and 2,750 mg for women, 75 percent of which comes from processed foods. (2, 3) Fewer than 20 percent of Americans engage in regular physical activity, (4) and fewer than 25 percent consume five or more servings of fruits and vegetables daily. (5) The prevalence of these characteristics is high. The prevention and management of hypertension are major public health challenges for the United States.

**********

For more than three decades, the National Heart, Lung, and Blood Institute (NHLBI) has administered the National High Blood Pressure Education Program (NHBPEP) Coordinating Committee, a coalition of major professional, public, and voluntary organizations and federal agencies to issue guidelines and advisories designed to increase awareness, prevention, treatment, and control of hypertension (high blood pressure [BP]).

Since inception, there were several published joint reports. The current Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) published in May 2003 was based on the premise that there were many new hypertension observational studies and clinical trials since the last report was published in 1997, (6) the need for a new, clear, and concise guideline that would be useful to clinicians; the need to simplify the classification of BP; and a clear recognition that the JNC reports did not result in maximum benefit to the public.

The purpose of JNC 7 is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are as follows: (7)

* in those older than age 50, systolic blood pressure (SBP) of > 140 mmHg is a more important cardiovascular disease (CVD) risk factor than the diastolic BP (DBP);

* beginning at 115/75 mmHg, CVD risk doubles for each increment of 20/10 mm Hg;

* those who are normotensive at 55 years of age will have a 90 percent lifetime risk of developing hypertension;

* prehypertensive individuals (SBP120-139 mmHg or DBP 80-89 mmHg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD;

* for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes;

* two or more antihypertensive medications will be required to achieve goal BP (<140/90 mmHg, or <130/80 mmHg for patients with diabetes and chronic kidney disease);

* for patients whose BP is > 20 mmHg above the SBP goal or 10 mmHg above the DBP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered.

Regardless of therapy or care, hypertension will only be controlled if patients are motivated to stay on their treatment plan. As the report states, the Committee continues to recognize that the responsible physician's judgment remains paramount.

Substantial Improvements

Fifty million or more Americans have high BP warranting some form of treatment according to the National Health and Nutrition Examination Survey (NHANES). (8, 9)

Worldwide prevalence estimates for hypertension may be as much as 1 billion individuals, and approximately 7.1 million deaths per year may be attributable to hypertension. The World Health Organization (WHO) reports that suboptimal BP (>115 mmHg SBP) is responsible for 62 percent of cerebrovascular disease (CVD) and 49 percent of ischemic heart disease (IHD), with little variation by sex. In addition, suboptimal BP is the number one attributable risk factor for death throughout the world. (10)

Considerable success has been achieved in the past in meeting the goals of the program. The awareness of hypertension among Americans has improved from a level of 51 percent in the period of 1976-1980 to 70 percent in 1999-2000 (Table 1).

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Moment of Truth on Hypertension
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.