By Jonathan Springston, Editor, Relias Media

U.S. Surgeon General Jerome M. Adams, MD, MPH, released a “call to action” asking all Americans to make hypertension a national health priority.

In a 52-page report, Adams argues the United States has “hit a plateau in hypertension control,” and offers 10 tactics for prevention and control, including eliminating disparities in healthcare access, providing access to healthy food, and connecting patients to resources that can assist with lifestyle modifications.

“We know that lifestyle changes, such as being physically active and adopting a healthy diet, can promote hypertension control, yet many communities have significant barriers that prevent people from making these changes. We also know that many people with hypertension require medications to achieve control,” Adams wrote in the report. “Access to high-quality healthcare, prescription of appropriate medications, and clinical and community support are needed to prevent and treat hypertension, publicize local resources, and establish a plan for care supportive of long-term control.”

The report notes more than 100 million Americans live with hypertension, defined as blood pressure higher than 130/80 mmHg, but nearly three out of four of those are living with uncontrolled, untreated hypertension. Left untreated, these patients are at much higher risk for strokes, heart attacks, kidney disease, and other maladies.

More than half of Black women and men live with hypertension, developing the condition at a younger age and grappling with worse outcomes vs. white patients. The report underscores the economic, social, and environmental barriers to proper care that lead to these disparities.

“We applaud the surgeon general for urging sectors to create tailored strategies aimed at improving reach and equity, given disparities in blood pressure control remain persistent, with lower control rates in Black, Latinx, Asian, and Native American adults compared to white adults. We also know that cardiovascular disease places vulnerable populations at greater risk for adverse outcomes associated with COVID-19,” American Medical Association President Susan Bailey, MD, said in a statement.

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines redefined diastolic hypertension (DH) as higher than 80 mmHg. In the September 2020 issue of Clinical Cardiology Alert, Michael Crawford, MD,  argued these changes “caused quite a bit of controversy over the stricter definition of systolic hypertension to > 130 mmHg.”

“Such measurements mainly revolved around older individuals in whom systolic BP naturally tends to increase with age and in patients with conditions such as coronary artery disease in whom higher pressures may be required to perfuse the myocardium,” Crawford explained. “At the other end of the spectrum are subjects with isolated DH who more frequently tend to be young men. The new definition of DH raised the prevalence of it several-fold …. This decision was based largely on older epidemiologic data that showed an increase in the risk of developing CVD at diastolic BPs > 75 mmHg and expert opinion.”

An analysis of three large prospective databases showed the revised definition resulted in a 5% higher prevalence of DH, which was not significantly associated with CVD outcomes.

“Perhaps more importantly, there was no signal of subclinical organ damage, as evidenced by no significant changes in troponin and BNP. Prior studies have shown an association with DH and the development of later systolic hypertension, which was not analyzed in this study,” Crawford wrote in his review. “Despite this possibility, there is no indication for drug treatment of isolated DH. This advice is consistent with the Hypertension Optimal Treatment study, which did not show any benefit to reducing diastolic BP from 90 to 80 mmHg. Periodic surveillance for systolic hypertension would seem reasonable.”