Hypertension

Over 43 million adults in the United States have hypertension, but 31% are unaware of their elevated blood pressure; 17% are aware but untreated; 29% are being treated but have not
controlled their blood pressure (still greater than 140/90 mm Hg); and only 23% are well controlled. In every adult age group, higher values of systolic and diastolic blood pressure
carry greater risks of stroke and congestive heart failure.Systolic blood pressure is a better predictor of morbid events than diastolic blood pressure. Clinicians can apply specific blood pressure criteria, such as those of the Joint National Committee, to decide at what levels treatment should be considered in individual cases. Table 11–1 presents a classification of hypertension based on blood pressures.
Primary prevention of hypertension can be accomplished by strategies aimed at both the general population and special high-risk populations. The latter include persons with high-normal blood pressure or a family history of hypertension, blacks, and individuals with various behavioral risk factors such as physical inactivity; excessive consumption of salt, alcohol, or calories; and deficient intake of potassium. Effective interventions for primary prevention of hypertension include reduced sodium and alcohol consumption, weight loss, and regular exercise. Potassium supplementation lowers blood pressure modestly, and a diet high in fresh fruits and vegetables and low in fat, red meats, and sugar-containing beverages also reduces blood pressure.
Interventions of unproven efficacy include pill supplementation of potassium, calcium, magnesium, fish oil, or fiber; macronutrient alteration; and stress management.
Improved diagnosis and treatment of hypertension is a major cause of the recent decline in stroke deaths. Hypertension control, however, remains suboptimal. An intervention that included patient education and provider education was more effective than provider education alone in achieving control of hypertension, suggesting the benefits of patient participation in hypertension treatment.