In 2012, the U.S. Centers for Disease Control and Prevention announced the Million Hearts Campaign. The goal of this public-health initiative is the prevention of 1 million heart attacks in the U.S. by 2017.
The initial effort of the campaign focused on the control of high blood pressure. This should not be surprising because medical studies have shown high blood pressure, at the population level, is the leading risk factor for death from cardiovascular disease. The other major cardiovascular risk factors are high cholesterol, smoking, diabetes mellitus and a family history of heart disease.
High blood pressure is sometimes called the silent killer. In most instances, when blood pressure is elevated, there are no symptoms. Yet the cumulative effect of uncontrolled high blood pressure is damage to the large and small arteries in the body. This can result in damage to vision, kidney function and circulation in the legs. The most concerning potential adverse effects of uncontrolled high blood pressure, however, are heart disease and stroke.
During the last eight to nine months, there have been five new national and international guidelines regarding the management of high blood pressure. These guidelines, sponsored by various well-respected national and international health organizations, are in general agreement about both the definition of high blood pressure and measures to control it.
Experts agree that lifestyle measures are the basis for blood pressure control. Maintaining a healthy weight, reducing sodium intake and regular aerobic activity such as walking briskly 30 minutes daily have all been shown to facilitate blood-pressure control.
It is known that with age, the flexibility of arteries decreases. This results in an age-related increase in blood pressure. This can be worsened by excessive weight, high sodium intake or sedentary lifestyle.
While lifestyle measures form the basis for all strategies for blood pressure control, medication therapy can be quite effective at reducing blood pressure and, in turn, reducing the risk of adverse cardiovascular outcomes such as heart attack and stroke.
Recent blood-pressure guidelines generally agree that four major families of blood-pressure control medications are the most effective both at reducing blood pressure and, more importantly, reducing the risk of adverse cardiovascular outcomes.
The use of these medication families – known as thiazide diuretics, ACE-inhibitors, angiotensin receptor blockers and calcium channel blockers – are supported by strong evidence from multiple well-designed health studies.
Of course, no major public-health guidelines are without some controversy. As to blood pressure control, the main controversy has been a modest relaxation of target blood-pressure levels among the elderly. However, even on this topic, most of the guidelines agree, based on scientific data.
It is important to know blood-pressure control targets and medication treatment strategies must be tailored to each patient. Because elevated blood pressure produces few, if any, symptoms in early stages, a blood-pressure check, at least yearly, is wise. If blood pressure is elevated, consultation with a health-care provider is important to determine the best strategy for blood pressure control.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
