1. Promising Practices Related To The Prevention, Control and Treatment of Hypertension
David J. Hyman, MD, MPH
Professor of Medicine and
Family & Community Medicine
Baylor College of Medicine
President elect - Texas Chapter of the American Society of Hypertension

2. Problems Hypertension is an extremely important Risk factor for
heart disease, stroke, Renal failure, CHF and all the
complications of diabetes
Population BP has stopped going down
About 35% of people with hypertension are still
unaware of it
About 35% of people being treated for hypertension are
not controlled to target

3. Age Standardized Prevalence of Hypertension in the United States
National Health and Nutrition Survey (NHANES) ( )
Non-Hispanic Mexican- African-
white American American
27.4% % %

4. Prevalence of Hypertension in the United States*
The prevalence of hypertension in a representative sample from the National Health and Nutritional Examination Survey (NHANES 19992000) reveals that approximately 28.4% of the United States adult population has hypertension and that the prevalence of hypertension increases sharply with advancing age. The NHANES 19992000 survey was conducted in the United States among a representative sample (n=4,531) of adult, noninstitutionalized, nonpregnant civilians with the goals of 1) estimating the prevalence of selected diseases and risk factors; 2) estimating population reference distributions of certain health parameters; 3) documenting and investigating reasons for secular trends in selected diseases and risk factors; 4) contributing to an understanding of disease etiology; and 5) investigating the natural history of selected diseases.
References:
National High Blood Pressure Education Program Coordinating Board. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:
Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004;44: †
Age
*Based on NHANES 19992000 data. Hypertension is defined as
blood pressure 140/90 mmHg or antihypertensive treatment.
†Low reliability due to large relative error.
Fields et al. Hypertension. 2004:44;

5. Hypertension Control in U.S. - NHANES
% of Treated Controlled 30
% of Treated Controlled 43
% of Treated Controlled 51
% of Treated Controlled 64
% of Treated Controlled 65
Ong, Hypertension 2007

6. Primary Prevention of Hypertension via food supply sodium reduction:
A growing international trend that TEXAS should join
1.3 gm average daily decrease will prevent 5mm/HG rise in BP with age and save 150,000 lives year
- Most sodium is in processed food
- Individual action is extremely difficult
- Commercial alternatives exist
- Food supply interventions are occurring around the world
Dickinson, AMA council of scientific affairs, archives IM 2007

7. International Efforts
England
Department of Health and Food standards agency goal 2.4 gm
sodium by 2010
50 food manufactures have signed on and begun to reduce
Ireland
Pressuring food industry
New Zealand / Australia
Strict labeling
Industry pressure to reduce sodium has reduced
Sodium in breads, cereals, margarine
France
Goal 20% reduction in 5 years
Finland
National focus since 1970s
Sodium decrease from 4700 to 3300
Population decrease in blood pressure

9. 30% of Hypertensives Unaware!

10. Of the unaware hypertensives…
Mexican Americans are very over represented
But
90 % of Unaware have insurance
80% have a usual source of care
75% had a BP measurement in the last year
96% had a BP measurement in the last 4 years
Mean age 58
Mean BP 148/83
Hyman NEJM 2001

11. Implication: New screening programs needed Hispanics Low utilizers
Education programs needed for health providers and
public on appropriate reaction to “mild” BP elevations
New technologies and paradigms for BP
measurement may be needed.

12. Improving control in treated patients
Continue public and physician education
Appreciate limits on scientific data on achieving goals
Educate on the availability of low cost drugs

13. Hypertension Treatment
by Drug Class
CCBs
ß-Blocker
ACE Inhibitors
Diuretics
ARBs
IMS Health NDTI,

14. Cost of market leaders Norvasc $84 month Valsartan $74 month
What you can get for $ 4 per month from Walmart (web 9/07)
ACE Benezepril
Lisinopril
B blocker Metoprolol (BID)
Atenelol
Carvedilol (BID)
Thiazides*
Clonidine*
Lovastatin ,20
Pravastatin

15. Big pharma can’t make any $ on BP Drugs…
If BP drugs are cheap…
Big pharma can’t make any $ on BP Drugs…
If big pharma controls the flow of medical information…
and big pharma looses interest in Hypertension…
The public health community will have to keep
blood pressure control on the agenda by our selves!!
The population will suffer if we don’t.