Hypertension, or high blood pressure, is the leading risk factor for heart disease, and improvements in both targeted and population-based strategies for blood pressure control can lead to better prevention and control of hypertension.

The study was published in the Journal of the American College of Cardiology. This paper is part of an eight-part health promotion series where each paper will focus on a different risk factor for cardiovascular disease.

Prevalence

The prevalence of hypertension globally is high and continues to increase. High blood pressure is associated with an increased risk of stroke, ischemic heart disease, heart failure and noncardiac vascular disease, as well as other conditions.

Hypertension

Hypertension is caused by a combination of genetic, environmental and social determinants. While genetic predisposition is nonmodifiable and conveys lifelong cardiovascular risk, the risk for hypertension is modifiable and largely preventable due to strong influence by key environmental and lifestyle factors.

Modifiable lifestyle factors, which are gradually introduced in childhood and early adult life, include being overweight/obesity, unhealthy diet, high sodium and low potassium intake, insufficient physical activity, and consumption of alcohol. Many adults do not change their lifestyle after being diagnosed with hypertension and sustaining any changes that are made can be difficult.

Risk Factors For Hypertension

Social determinants such as race and socioeconomic status are also risk factors for hypertension. High blood pressure is more prevalent in black and Hispanic populations as well as poorer areas and certain geographical areas such as the southeastern U.S.

According to the authors, prevention and control of hypertension can be achieved through targeted and population-based strategies. The targeted approach is the traditional strategy used in healthcare practice and seeks to achieve a clinically important reduction in blood pressure for individual patients. 

The population-based strategy aims to achieve small reductions that are applied to the entire population, resulting in a small downward shift in the entire blood pressure distribution. Studies have shown that the population-based approach may be better at preventing cardiovascular disease compared with the targeted strategy.

Factors preventing successful hypertension control include inaccurate blood pressure measurement and diagnosis of hypertension, lack of hypertension awareness and access to health care, and proper hypertension treatment and control. Low rates of medication adherence is also a common problem.

In the review, the authors discuss the Chronic Care Model, a framework for redesigning health care and addressing deficiencies in the care of chronic conditions such as hypertension, which may offer strategies for overcoming barriers at the health system, physician, patient and community levels. 

Community groups and organizations also play a significant role in providing healthcare information and support to various populations. Connected health, such as telemedicine and telephone and mobile health interventions can also help deliver improved care to an of a greater number of patients with hypertension.

Blood Pressure

Remarkable progress has been made in the understanding of blood pressure as a risk factor for heart disease and improving approaches to the prevention and treatment of hypertension. However, further research is still necessary to optimize care for these patients.