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Progress in Chronic Disease Prevention Advancements in Meeting the 1990 Hypertension Objectives

Nine of the 226 health objectives for the nation published in 1980 deal with control of high blood pressure (1,2). A review of progress toward these goals indicates that Americans are increasingly recognizing the causes of hypertension; taking steps to identify it; and, to a great extent, managing it through medical care and changes in personal lifestyle (3,4). The net result of this is declining mortality from hypertension-mediated causes.

Three principal areas of concern expressed by the National Institutes of Health (NIH), the federal lead agency for hypertension control, include: 1) increasing the public's knowledge of high blood pressure and related sequelae, 2) encouraging adoption of behaviors conducive to high blood pressure control, and 3) implementing systems designed to improve surveillance and control methods. The hypertension objectives are a priority because improved high blood pressure control rates will result in reduced mortality from cardiovascular disease, especially stroke.

In the past decade, awareness of hypertension has increased, and treatment and control have improved. There has also been a decline in stroke mortality. Table 5 presents data from the National Health and Nutrition Examination Surveys and data from the National Heart, Lung, and Blood Institute's Seven States Demonstration Projects (National Heart, Lung, and Blood Institute, unpublished data) (5,6). In the survey covering 1971-1972, 51% of persons with hypertension were aware of their condition. By the 1982-1984 survey, 85% of hypertensives were aware that they had high blood pressure. During this same period, the proportion of hypertensives under treatment increased from 36% to 74%. The prevalence rates of controlled hypertensives (160/95mm Hg) rose from 16% for the period 1971-1972 to 57% for 1982-1984.

Evidence of progress in meeting a number of the nation's high blood pressure objectives by 1990 is available from probability surveys conducted by NIH and the National Center for Health Statistics (NCHS). These surveys were conducted in 1973, 1979, 1982, and 1985 and describe trends in the public's knowledge of high blood pressure, heart disease, and stroke (7,8,9). For example, in 1973, 29% of respondents who were asked an open-ended question on the consequences of high blood pressure stated that high blood pressure causes stroke. This percentage rose to 38% in 1979 and to 59% by 1982. Likewise, in 1973 only 24% of respondents stated that high blood pressure leads to heart disease; in 1979 the percentage was 37%; and by 1982 it had increased to 71%. In 1985, the health promotion/disease prevention portion of NCHS's National Health Interview Survey showed 77% of the general public regarded high blood pressure as the major condition that predisposes a person to having a stroke (9). Ninety-one percent of respondents indicated that high blood pressure increases a person's chances of experiencing heart disease. Since the first of these surveys was conducted, many government agencies, professional societies, and voluntary organizations have worked together to provide public education programs on the consequences of uncontrolled hypertension.

Reducing salt consumption is an important control method for hypertensives. From 1972 to 1985, there was a steady decline (36%) in food-grade salt sales. In 1972, consumers purchased an average of 2.25 pounds of salt per person; by 1985, sales averaged 1.44 pounds per person (The Salt Institute, unpublished data). Reported by C Lenfant, MD, National Heart, Lung, and Blood Institute, NIH; Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Public Health Service.

Editorial Note

Editorial Note: Stroke remains the third leading cause of death in this country; 152,710 Americans died in 1985 from this condition alone (10). Black Americans continue to have more hypertension than their white counterparts, and increased efforts to control hypertension are needed in this population. Awareness of the consequences of uncontrolled hypertension has increased since the 1971-1972 survey; however, compliance with medical regimens must increase, and there must be persistent efforts to get hypertensives to stay on therapy. Therefore, education strategies must shift from awareness of the disease to skill building, which will promote continued therapy. In addition, there is a need for patient tracking systems that will help health care providers identify persons whose hypertension is not under control.

While the challenges are formidable, there is evidence that current efforts have been effective. The decline in age-adjusted stroke mortality began to accelerate in 1972, the year the National High Blood Pressure Education Program (NHBPEP) began. If the expected mortality rates of 1960 to 1972 had prevailed until 1985, approximately 77,500 more Americans would have died from stroke in 1984 alone (National Heart, Lung, and Blood Institute, unpublished data).

The National Heart, Lung, and Blood Institute has led the efforts to coordinate the many agencies and programs comprising the NHBPEP. The NHBPEP Coordinating Committee has developed a variety of consensus reports that have led policy makers to develop blood pressure control programs. During 1986, NHBPEP prepared reports on blood pressure levels in children, management of hypertension in the elderly, and management of the hypertensive patient who also has diabetes. CDC is developing new program objectives for chronic diseases and working with state health departments. These activities should assist in meeting the national objectives to control hypertension. NCHS continues to provide invaluable data from their National Health Interview Surveys and National Health and Nutrition Examination Surveys. The Food and Drug Administration's regulation of sodium labeling for processed foods as well as their studies on food labeling and packaging have been helpful in monitoring progress on hypertension and sodium awareness. The Health Resources and Services Administration has been delivering essential medical care to the underserved through continued support of state health care activities and through primary care programs for Indians, migrants, and populations served by neighborhood health centers. The Office of Disease Prevention and Health Promotion of the Public Health Service has coordinated the development and progress reviews of the national health objectives, which have become important milestones in improving the nation's health. Continued diligence by both public and private organizations will help to assure that, by 1990, the nation's hypertension objectives will have been largely met.

References

  1. US Department of Health, Education, and Welfare. Healthy people: the Surgeon General's report on health promotion and disease prevention. Washington, DC: US Department of Health, Education, and Welfare, 1979; DHEW publication no. (PHS)79-55076.

  2. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, 1980.

  3. Roccella EJ, Bowler AE, Ames MV, Horan MJ. Hypertension knowledge, attitudes, and behavior: 1985 NHIS findings. Public Health Rep 1986;101(6):599-606.

  4. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, 1986:15-23.

  5. Roberts J. Blood pressure levels of persons 18-74 years--United States, 1971-1972. Hyattsville, Maryland: National Center for Health Statistics, 1975 (Vital and health statistics; series 11; no. 150).

  6. Roland J, Roberts J. Blood pressure levels and hypertension in persons ages 6-74 years: United States, 1976-1980. Advance Data 1982;84:1-12.

  7. National Institutes of Health. The public and high blood pressure: six-year followup survey of public knowledge and reported behavior. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1981; DHHS publication no. (NIH)81-2118.

  8. National Institutes of Health. Public perceptions of high blood pressure and sodium. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1986; DHHS publication no. (NIH)86-2730.

  9. National Center for Health Statistics. Health promotion data for the 1990 objectives: estimates from the National Health Interview Survey of health promotion and disease prevention--United States, 1985. Advance Data 1986;126:1-16.

  10. National Center for Health Statistics. Annual summary of births, marriages, divorces, and deaths, 1985. Monthly Vital Statistics Rep 1986;34(13):1-28.



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