Hypertension paradox

What is the paradox?

Dr Aram Chobanian, a world-renowned cardiologist and the Dean of the Boston University Medical School, wrote in the NEJM special article that despite the remarkable successes in lowering blood pressure in patients with hypertension, the prevalence of hypertension continues to increase worldwide. The number of people with uncontrolled blood pressure is also increasing.

He reviewed the development of the anti-hypertensive drug therapy and other evolving approaches such as lifestyle modifications. He recommended a new treatment algorithm for the management of stage 1 and 2 hypertension.

He noted that recent data indicated that about 28% of Americans with hypertension are unaware of their condition, 39% are not receiving treatment and 65% do not have their BP controlled. The controlled rates are even worse in patients with chronic kidney disease, diabetes, and other cardiovascular dysfunction in whom target BP levels of 130/80 mm Hg are recommended.

With the prevalence of hypertension continues to increase worldwide, he asked “what can be done to reverse this trend”. He pointed out that “salt intake and body weight are particularly important in the age-related increase in BP” but some countries such as Finland and GB have achieved significant reductions in dietary sodium through aggressive efforts including education and working with the food industry.

He said that “the failure to adopt healthy lifestyles has been a critical factor in this increase” and must be addressed urgently. He urged a national strategy to promote physical activities combined with changes in dietary intake.

This article was presented as the Shattuck lecture of the Massachusetts Medical Society and available as open access at the NEJM website.

Source: “The Hypertension Paradox — More Uncontrolled Disease despite Improved Therapy” NEJM 2009, 361(9):878-887