Prevention and Control of Hypertension: JACC Health Promotion Series

Abstract

Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.

Keywords: antihypertensive agents; dietary sodium; exercise; lifestyle; medication adherence; telemedicine.

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Figures

Central Illustration.. Prevention and Control of Hypertension.

Factors associated with hypertension awareness, treatment, and control, and the components of a systems-level algorithm designed to increase blood pressure (BP) control. Carey, R.M. et al. J Am Coll Cardiol. 2018;72(11):1278-93.

Figure 1:. Schematic Depiction of the Major Determinants of BP in Primary Hypertension and Their Interactions in Adults.

Genetic/epigenetic, environmental, and social determinants interact to increase BP in virtually all hypertensive individuals and populations. BP = blood pressure. SD = social determinants.

Figure 2:. Schematic Illustration of the CCM, Including Multilevel Interventions to Prevent and Control Hypertension.

Adapted with permission from Wagner (132). CCM = chronic care model; HT = hypertension.