Stroke Discriminates and It’s on the Rise.
We need to help people control their blood pressure now.
By Warren A. Jones, MD, FAAFP and John M. Clymer
There are at least two reasons why high blood pressure is called “the silent killer,” and both are underscored in a new research report published today in Hypertension, co-authored by National Forum chief scientific advisor, Stephen Sidney.
The common reason is that, “It is not until a person’s blood pressure is really high that people feel any symptoms,” Jamal Rana, chief of cardiology at Kaiser Permanente Oakland Medical Center and a report co-author, explains.
The other reason is even more pernicious. The U.S. has suffered, in near-silence, an epidemic of high blood pressure or hypertension for years, long before anyone had heard of SARS CoV-2 and it will be with us long after the nation reaches herd immunity against COVID-19. High blood pressure or hypertension is a prime cause of the #1 cause of death, heart disease, the #5 cause, stroke, as well as heart failure, and kidney failure. It can also cause pregnancy complications and cognitive decline. It is right there, touching people on nearly every block in every community in our nation, yet it rarely gets a mention on nightly newscasts, let alone full segments or special reports.
One might ask, Hypertension has been with us a long time, so why should we pay more attention to it now as we are focused on ending the COVID-19 pandemic? There are compelling answers.
First, the U.S. is losing ground on hypertension control. Nearly half of American adults have high blood pressure. Of those who have it, fewer than half have it under control and that number is declining.
Second, while hypertension is common among all races, there are significant racial and geographic disparities. These differences help to explain why COVID-19 disproportionately harmed and killed Americans of color. Using data from CARDIA, an ongoing study that began in 1985, Sidney, Rana, et al, found that the stroke rate is four times higher for young and middle-aged Black adults than their White counterparts. This is true after adjusting for other risk factors such as smoking, diabetes, etc.
Third, while stroke is unusual in young to middle-aged adults, it appears to be rising at an alarming rate. Sidney, Rana, et al found that from 2000 to 2010, rates of hospitalization for acute ischemic stroke increased by 43% for 25–44-year-olds.
Even as the nation takes steps necessary to emerge from the COVID-19 pandemic, it must set the stage to answer the Surgeon General’s 2020 Call to Action to Control Hypertension. Rana says, “the constant challenge is to get people to proactively think about blood pressure control.”
Sidney urges people to follow “the healthy habits specified in the American Heart Association’s Life’s Simple 7. Developing these habits, which include eating a healthy diet, taking part in regular physical activity, not smoking, and maintaining a normal weight, early in life, can help keep young adults from developing hypertension, and prevent them from having a stroke.”
The Surgeon General’s Call to Action includes evidence-based strategies for both clinical and community settings. Historically, most attention has been paid to clinical interventions because, unlike the rest of the developed world, the U.S. spends most of its health dollars on medical care. Hypertension warrants much more attention in clinical care. Thirty National Forum members and allies signed a Joint Policy Statement on Expanding Access to Care. It identifies evidence-based policies that will improve hypertension control and cardiovascular health and increase access to care in underserved areas.
The root causes of hypertension are in the community. The National Forum is helping mayors address them in multiple ways. Mayors are raising awareness about blood pressure in their communities, using fact-based messaging provided by the National Forum. Mayors use the National Forum’s Move with the Mayor™ platform to promote active lifestyles, and advance policies and environments that enable people to build Life’s Simple 7 into their daily lives.
Warren A. Jones, MD, FAAFP, is Chair of the National Forum for Heart Disease & Stroke Prevention and Professor Emeritus of Family Medicine, University of Mississippi Medical Center.
John M. Clymer is Executive Director of the National Forum for Heart Disease & Stroke Prevention and Co-Chair of the National Hypertension Control Roundtable.
 Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324.
 Muntner P, Hardy ST, Fine LJ, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018. JAMA. 2020;324(12):1190–1200. doi:10.1001/jama.2020.14545
 Ferdinand KC, Yadav K, Nasser SA, et al. Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence. J Clin Hypertens (Greenwich). 2017;19(10):1015-1024. doi:10.1111/jch.13089
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