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February 22nd, 2010
05:48 PM ET

Report: Hypertension a neglected public health issue

By Ashley Fantz
CNN.com Writer Producer

High blood pressure is killing more Americans than ever, but it's being neglected as a public health issue and doctors are not adequately diagnosing it, according to medical experts who worked on a new report issued Monday by the Institute of Medicine, an independent, nonprofit organization based in Washington, D.C.

High blood pressure is a major contributing cause of heart disease, the nation's leading cause of death for men and women. Cancer ranks second. Heart disease killed 631,636 people and cancer killed 559, 888 people in 2006, the most recent year the Centers for Disease Control and Prevention has data available. Hypertension is the second leading cause of preventable deaths; smoking is number one, according to IOM.

The 155-page report, sponsored by the CDC, says that currently one in three people have high blood pressure - measured at 140 over 90 or higher. The figure of one in three people is an increase from 2005 when one in six adults suffered from high blood pressure, according to Dr. Corinne Husten.

An increase in blood pressure translates to a hefty price tag for health care. Hypertension prevention and control is only one of a number of programs competing for $54 million last year in the CDC’s entire Heart Disease and Stroke Prevention portfolio, the report states. The American Heart Association recently reported that the direct and indirect costs of high blood pressure as a primary diagnosis was $73.4 billion in 2009.

The former chief epidemiologist and acting director of the Office on Smoking and Health at the CDC, Huston was part of a 10-person panel of medical doctors, epidemiologists and Ph.D.s who took roughly a year to review more than 100 existing studies on high blood pressure. Many of those studies included comprehensive information from national surveys that reviewed patient medical records, she said.

"We looked at how many times a patient had been to see a clinician, and [in those instances] when high blood pressure was recorded but those patients were either not given treatment or medication, or nothing, in general, was done," Huston said.

It's unclear why doctors are not following guidelines on how to treat hypertension, panel members told reporters Monday. "A lot of people who have hypertension don't know it because clinicians aren't telling them that their numbers are high," according to the epidemiologist.

Why are more Americans suffering from high blood pressure?

"We can blame our high intake of sodium in the food we buy at grocery stores or eat in restaurants, our lack of potassium in our diets, that we don't get enough exercise," said Husten.

An adult should be consuming a teaspoon of salt a day, said David Fleming, chair of the IOM panel and the director of King County public health in Washington state. The elderly or someone already suffering from high blood pressure should get no more than two-thirds of a teaspoon of salt each day. But measuring that is, practically speaking, extremely difficult.

"One has to remember that the food you buy already has sodium in it before you use your salt shaker," he said.

The report recommends ways to address the increase in high blood pressure, including a familiar call to eat more vegetables and fruit, work out more and ask a restaurant exactly how much salt meals contain.

The CDC should also work with schools to encourage them to strengthen or implement physical fitness programs and work with food industry professionals to tamp down on the amount of salt put in food, the report advises.

The report also suggests requiring providers to allow patients to make smaller co-pays in order to get medications and have doctor visits. Another option would be to require providers to issue more rigorous treatment guidelines to doctors.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (9 Responses)
  1. K. Brown

    It seems so hard to limit salt intake to just one teaspoon a day as previously stated, b/c of all the sodium already in foods. Since my husband has been diagnosed with hypertension and high cholestorol, I've been trying to buy as many fresh products as possible and limiting processed foods to a minimum. We've started an exercise routine and trying to lose the extra weight. The food aspect seems so much harder b/c we don't want to sacrafice flavor and generally salt has to be used at some point. I mean it's hard to stick to a diet when you don't like what you're eating. With that said...I'm still making an effort to be very conscience of what I'm adding to the foods I cook. Who knew getting heathier would be so difficult!

    February 23, 2010 at 08:30 | Report abuse | Reply
  2. Lauren Ring

    What about those of us with hypotension? Is that not highly neglected? We always hear about the risks of high blood pressure and the potential causes and treatment, but I have NEVER heard of a single commercial, publicized medication, or treatment plan for hypotension. Mine is regularly at about 90/50, and I do not exercise, I have a normal 'teenage' diet. I have to be put on blood pressure medications to RAISE mine. This is an issue that needs to be publicised as well. Hypertension is only one end of the spectrum/

    February 23, 2010 at 12:53 | Report abuse | Reply
  3. M. Edwards

    My doctors nurse never really checks blood pressure like it's important. They all do it really quick and don't pay much attention to it. So I went down about a year ago and bought my own. Since then I have watching my pressure and the systolic is always high at 148 or so and the other is fine. I had to inform my doctor fo this and not the other way around. I did a little research and I learned that what I have is called systolic hypertension. My doctor has not told me that. They have me on some kind of blood pressure med but evidently it's not doing it's job becuase my pressure has not changed. Quite a few times now it feels like my head is going to pop and I feel like it's becuase of my high pressure. What should I do?

    February 23, 2010 at 13:51 | Report abuse | Reply
  4. Ron Benfield

    Hello Dr. Gupta
    I watched your report on high blood pressure today. I am confused. On the website of the Mayo Clinic, it states that in “90 to 95 percent of high blood pressure cases in adults, there's no identifiable cause”. Additionally, for the remaining 5% to 10% for whom there is an identifiable cause, salt is only mentioned as one of numerous possible causes.
    If this is so, why do doctors often recommend to everyone with high blood pressure that they reduce salt intake? As it relates to the 90% to 95% for whom salt is not a causative factor, are they in fact saying that even though salt is not a factor in causing it, reducing salt intake can be a factor in controlling it? I don’t get it.

    February 23, 2010 at 13:53 | Report abuse | Reply
  5. Aaron Bolesta

    Has anyone studied the relation between insulin and effects on blood pressure? I'm finding that insulin resistance leads to magnesium deficiency, which then leads to blood vessel constriction and hypertension. Eating healthy foods and severely limiting sugar can lower blood sugar, and is much cheaper and safer than medication. Some more information is provided here http://www.true-healthy-foods.com/index.html

    April 21, 2010 at 19:25 | Report abuse | Reply
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  7. Patti Cee

    Hypertension a neglected problem? No way! That's all most doctors know to do! I've been to umpteen doctors who could play with the blood pressure cuff, prescribe BP drugs, but could not treat an illness with symptoms! That's the main reason I fire doctors.

    June 15, 2013 at 13:42 | Report abuse | Reply
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    June 15, 2013 at 13:50 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.