Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
The old adage should always apply: Treat the person and not the disease. Yet when it comes to high blood pressure, or hypertension, we often don’t think this way. There’s a tendency to address only the numbers and opt for a quick fix with a prescription or 2. But that approach misses an opportunity to understand all the factors contributing to someone’s high blood pressure and potentially help improve their broader health outcomes. Preventing, identifying, and treating hypertension should be about much more than just measuring blood pressure and prescribing medicine. Instead, addressing high blood pressure should be an exemplar of comprehensive, person-centered care — promoting greater overall health, well-being, and personal resilience.
During this American Heart Month, we can all boost this idea and support prioritizing high blood pressure prevention and control through a more holistic approach in medical and public health practices. Ideally, the conversation about blood pressure between health professionals and patients — or the public — isn’t just about raising greater awareness of the harms. Instead, it should emphasize how engaging in healthy behaviors — like physical activity and healthy eating — can improve not only people’s blood pressure but also their overall health.
It’s important that we, as health care providers and public health professionals, take extra time to make certain the public knows what’s at stake: High blood pressure is one of the most common, costly, and preventable cardiovascular disease risk factors. Uncontrolled hypertension is common — affecting nearly half of all American adults. Only 1 in 4 people have adequate management of their high blood pressure. And 3 out of 4 American adults with hypertension have blood pressure greater than 130/80. In addition, many people are unaware they have high blood pressure. Referred to as a “silent killer,” high blood pressure often causes no symptoms, and it can quietly worsen until it leads to more dire outcomes.
Unchecked high blood pressure increases people’s risk for stroke, heart attack, vascular dementia, kidney disease, and eye problems. People with high blood pressure are also more likely to get severely ill from COVID-19. Of the hundreds of thousands of hospitalizations due to COVID-19, 26 percent have been attributable to hypertension. Overall, high blood pressure diminishes people’s resilience related to everything from disease to displacement after a natural disaster. No matter how you look at it, uncontrolled high blood pressure clearly leads to increases in unnecessary disease and death.
Making high blood pressure control a priority begins with universal awareness. On an individual level, that means people monitoring their blood pressure, understanding their numbers, and being aware of their risks. This is especially important for people at higher risk for high blood pressure, including people who:
- Are African American
- Have obesity or overweight
- Get less than the recommended amount of physical activity or don’t eat a healthy diet
- Smoke or drink too much alcohol
- Have kidney disease, diabetes, or some types of heart disease
Because hypertension often causes few or no symptoms, it’s important to encourage people to stay informed about their blood pressure and empower them to maintain it at a healthy level. Blood pressure screening is quick and noninvasive — and people can do their own screenings at home. In fact, blood pressure self-monitoring is an independent, proven approach to catch and improve high blood pressure and prevent its consequences.
For public health professionals, understanding the drivers of high blood pressure — including many social determinants of health — and the implications of hypertension across populations means addressing much broader concepts with focused attention. For example, fewer than 1 in 4 adults in this country meet recommendations in the Physical Activity Guidelines, and most Americans don’t follow a healthy eating pattern consistent with the Dietary Guidelines for Americans. In addition, more than half of adults have 1 or more chronic diseases related to lifestyle behaviors. Health professionals and organizations — and sectors of society apart from traditional health care — must take steps to better support individuals and communities with opportunities to make better informed and healthier lifestyle choices.
People providing direct clinical care also need to consider social determinants of health, including the variety of life circumstances that directly and indirectly contribute to high blood pressure. For example, a provider can suggest that someone get more physical activity, but if that person has barriers preventing them from becoming more active — such as a lack of safe spaces — then they’re less likely to act on the suggestion. Providers must ask themselves nuanced questions like:
- “What does this person eat?”
- “What do they do for ‘play’ or recreational activities?”
- “Where do they live and work?”
- “What life circumstances may be causing an elevation in blood pressure?”
In other words, we need to collectively better understand and invest in the person and their circumstances — not just the disease. We’ll need to routinely answer these questions and more if we want to make progress toward a more equitably healthy and resilient nation.
Small changes, like increasing physical activity, can affect the trajectory of high blood pressure. In fact, healthier blood pressure is one of the outcomes of getting active that we can see almost immediately: the benefits begin to appear even before someone gets to the recommended 150 minutes of weekly physical activity. Best of all, people who start to move more also reap the other benefits that come with increases in physical activity — including sleeping better, feeling better generally, and having an increased ability to perform daily tasks.
Diet also plays a major role in mitigating the development of — and managing — high blood pressure. Following a heart-healthy eating pattern — like the Dietary Approaches to Stop Hypertension (DASH) diet — and eating less salt can lower blood pressure significantly. The DASH eating pattern emphasizes vegetables, fruits, and whole grains and includes fish, poultry, beans, nuts, and healthy oils. A DASH diet is also limited in sodium, saturated fat, and added sugars. What’s more, following DASH can reduce people’s LDL cholesterol and their overall risk for cardiovascular disease.
Preventing and treating high blood pressure is about more than just the numbers. Every person with high blood pressure — half of all American adults — deals with unique social determinants of health and therefore has equally unique needs. Though we face many significant challenges in our efforts to improve Americans’ diet and nutrition and increase their physical activity, it’s critical to reinforce the importance of both in discussions about high blood pressure during clinical encounters or public discourse. When people see the improved outcomes that result from making a few changes in their everyday lives, they’ll realize just how much of an impact those changes can have on their personal well-being.
In considering heart health this month, we should make managing hypertension a priority — an exemplar — in the work to improve our overall health and strengthen our resilience. This can start with creating greater awareness and empowering the public with knowledge and opportunity to move more and sit less… and pass on the salty foods.
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis