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 The Southeast has been called the Stroke Belt
because of well-known high rates of cardiovascular disease,
including high blood pressure. But that knowledge has not led to
changes, nor to a full understanding of the reasons for the
population's high risk, the study team reports.
"The rates have not changed," though the U.S. has had treatment
guidelines for high blood pressure since 1977, said one of the
authors, Dr. Uchechukwu K. A. Sampson, an assistant professor of
medicine at Vanderbilt University Medical Center in Nashville,
Tennessee.
"The number of people who do not know that they have high blood
pressure is the same," he added.
High blood pressure is an established cause of death from
cardiovascular disease and accounts for up to 7.5 million deaths
worldwide each year, the researchers point out.
To investigate the persistently high rates of high blood pressure in
the South, Sampson's group used a large database with recent
information on men and women in southern states covering the years
2002 to 2009.
They focused on 69,000 white and black adults with similarly low
income and education levels - to eliminate poverty as a factor - and
analyzed what other causes might be contributing to blood pressure
problems.
Overall, they found that 57 percent of the study participants had
high blood pressure. Blacks were nearly twice as likely as whites to
be suffering from the disease, which has no symptoms of its own, but
can lead to stroke or kidney damage if untreated.
But the racial difference was seen mainly among women. Fifty one
percent of black and white men had high blood pressure, but the
rates were 64 percent among black women and 52 percent among white
women.
Obesity seemed to be a main driver of the problem, especially among
whites, with the most severely obese having more than four times the
risk of high blood pressure compared to normal weight men and woman.
Other factors linked to the likelihood of severe high blood pressure
included high cholesterol, diabetes, a history of depression and a
family history of heart disease.
The numbers Sampson's group found have not changed from previous
studies and that consistency is alarming, he said.
"Are they still the same factors people have found before?" Sampson
said. "If they are, that is bad news, then that means we have not
done what we should have done in the past few years."
Of the study participants who knew they had high blood pressure, 94
percent were taking at least one blood pressure medication, which is
a good thing, Sampson said. But only 30 percent were taking a
diuretic medication that promotes water loss from the body.
Diuretics should be one of the first-line medication options, the
authors write.
Black people were twice as likely as whites to have high blood
pressure without knowing it, Sampson said.
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That racial difference did not change even when researchers
accounted for differences in income and education, the authors write
in the journal Circulation: Cardiovascular Quality and Outcomes.
All of this lines up with what doctors and researchers already
knew, Sampson said.
Without specific studies, it's hard to say why population rates have
not gone down, and why so many people still do not know they have
high blood pressure, and why so few are on diuretics, he said.
Women may not actually be more predisposed to high blood pressure,
Sampson said, but they may be less aware of the risk than men.
Awareness efforts have historically focused on men when it comes to
heart and blood pressure problems, but women are equally likely to
have problems, he said.
"African-American women are known to have a very high prevalence of
hypertension and that its onset is significantly earlier than what
is seen in white women," Dr. John M. Flack said.
Flack is chair of the department of medicine at Wayne State
University at the Detroit Medical Center in Michigan.
Another explanation could be that obesity, clearly linked to blood
pressure, is more common for black women than for white women in the
general population, Flack said.
"We need to create more awareness that women also have this
problem," Sampson said. "Everyone should be treated equally
aggressively, with the same level of interest."
"Patients, be more proactive in monitoring your blood pressure," he
said. "Physicians should be much more proactive as well."
Better communication between patients and doctors might help bring
known treatments into practice and start to get population level
blood pressure down, he said.
In the meantime, other studies will need to probe why high blood
pressure has remained so common even as treatments have improved.
___
Source: http://bit.ly/K7sEfq
Circulation: Cardiovascular Quality and Outcomes, online Dec.
23
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