But in many societies where obesity is rare, activity levels are high and salt intake is low, blood pressure remains low throughout life. This is the best clue we have for the lifestyle changes needed to prevent illness and premature death caused by hypertension.
Claude Lenfant, who served as director of the National Heart, Lung and Blood Institute, is 81 and has a blood pressure of 115 over 60, a level rarely found among older Americans not taking medication for hypertension. His secret: a normal body weight, 6 or more kilometers walking daily, and no salt used to prepare his meals, most of which are made from scratch at home.
In an interview, Lenfant, who now lives in Vancouver, Washington, said the problem of hypertension was rising all around the world and added that by 2020 the number of people with uncontrolled hypertension was projected to rise 65 percent. One reason is that doctors today are more likely to diagnose the problem, so it is reported more often in population surveys. “But I’m much more concerned about the fact that so much high blood pressure is not controlled,” he said, and called “therapeutic inertia” an important reason.
It is not enough for doctors to write a prescription and tell patients to return for a check-up in six months, he said. Rather, a working partnership between health care professionals and patients is needed to encourage people to monitor their pressure, adopt protective habits and continue to take medication that effectively lowers pressure.
TREATMENT AND PREVENTION
Diuretics are a first-line and inexpensive remedy, but many patients with hypertension also need other drugs to lower pressures to a desirable level.
Chobanian, whose New England Journal report was titled “The Hypertension Paradox: More Uncontrolled Disease Despite Improved Therapy,” noted that “in the majority of patients, two or more antihypertensive drugs are required to achieve target blood-pressure levels.” In the interview, he emphasized the detrimental role played by diets high in salt and calories and low in protective fruits and vegetables — a result of portions that are too large, and of too many fast and processed foods that rely on salt to enhance flavor. “Generally, the average person in our society consumes more than 10g of salt a day,” Chobanian said, “but the Institute of Medicine recommends a third of this amount as optimal.”
A new RAND Corp study finds that a one-third reduction in salt consumption could save US$18 billion a year in direct medical costs. Chobanian called for better food labeling; changes in foods served in cafeterias, restaurants and schools; and less advertising on children’s television of unhealthy foods high in fat, salt and sugar. Also needed are better opportunities for all people to get regular exercise. “We have to focus more on children,” he said. “They’re the ones who will be getting cardiovascular diseases in the future.”
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