Dr. Rakotz currently serves as Vice President of Improving Health Outcomes at the American Medical Association (AMA), where he oversees efforts to develop and implement national quality improvement initiatives aimed at improving blood pressure control and preventing type 2 Diabetes. He is the AMA’s clinical lead of Target: BP® – a nationwide, multi-year collaboration with the American Heart Association to reduce the number of American adults living with uncontrolled hypertension.
WHAT CAUSES HIGH BLOOD PRESSURE?
How we live our lives really has the biggest impact on our blood pressure. There are many factors that contribute to a person having high blood pressure. Getting too much of certain foods – like salt or highly processed fast foods, or drinking too much alcohol – all of these can contribute to developing high blood pressure. Also, not getting enough of some things – like fruits and vegetables that have fiber, potassium and calcium, and not getting enough physical activity, will contribute to high blood pressure.
HOW DOES HIGH BLOOD PRESSURE AFFECT THE BLACK COMMUNITY?
African-Americans are much more likely to have high blood pressure than any other racial or ethnic group in the United States. And high blood pressure can be more severe in Black men and women, and often less responsive to many medications. Compared to white adults, Black adults are almost twice as likely to die from stroke, 50% more likely to develop heart failure, and four times more likely to have kidney failure. And these conditions are largely caused by uncontrolled high blood pressure.
The American Medical Association is working with the American Heart Association on a national initiative called Target: BP, with a goal to encourage healthcare teams to prioritize blood pressure control, and provide them with the most clinically up to date tools and resources to help them achieve this across the U.S. in all communities. We are trying to decrease the negative health consequences of high blood pressure and reduce the number of deaths it causes each year.
HOW IS HIGH BLOOD PRESSURE TREATED?
Lifestyle modification – losing weight loss if overweight, eating a healthy diet, and being physically active are recommended as the first treatment started to reduce high blood pressure. And proactively engaging in these lifestyle modifications can be effective at preventing the onset of high blood pressure.
If those things don’t work, or blood pressure is so high that it is unsafe to attempt lifestyle changes alone, medication is added. Some people may need more than one medication, but the lifestyle recommendations are always continued and are considered critical to achieving blood pressure control.
WHAT ARE THE SIDE OF EFFECTS OF HAVING HIGH BLOOD PRESSURE?
Consequences of uncontrolled high blood pressure are:
WHAT ARE SOME THINGS WE CAN DO TO IMPROVE OUR BLOOD PRESSURE?
We have talked about a few already. The best time to improve blood pressure is before it gets to the point of requiring medicine to treat it.
Eat a healthy diet low in salt and processed foods and with several servings a day of fruits and vegetables and whole grains, with healthy fats and lean proteins. Also, drink alcohol in moderation if you drink – that’s one drink a day maximum for women and 2 drinks a day maximum for a man.
Try to work your way up to being physically active – the goal is brisk walking 30 minutes 5 days a week. Its ok if being physically active happens 10 minutes at a time broken up throughout the day. And remember, any activity is better than no activity.
If you do these things you will likely be able to maintain a healthy weight, or lose weight if you are overweight, which is another important thing you can do to improve your blood pressure. If you are on medication, follow the plan you have made with your doctor and stay with it. I cannot stress enough the importance staying on your plan.
WHAT IS THE NEW HIGH BLOOD PRESSURE GUIDELINE?
The American Heart Association and The American College of Cardiology, along with nine other organizations, reviewed the science and wrote the first comprehensive update for doctors to learn how to prevent, detect, evaluate and manage people with high blood pressure. The last comprehensive guideline like this was published 14 years ago, in 2003.
WHAT DOES THIS NEW BP GUIDELINE MEAN?
The new guideline redefined high blood pressure as being lower than it was previously. Now, anyone with a persistently elevated blood pressure more than 130/80 mm Hg is considered to have high blood pressure. The number used to be 140/90. This means more adults in the U.S. have high blood pressure – roughly 46% or 103 million people.
Most of the people who now have high blood pressure because of this change will be treated earlier than in the past, and the treatment for almost all of them will be lifestyle modification, not medication. The age group most affected by this will be men under the age of 45, where the number of people with high blood pressure will triple. But again, most will be treated with recommendations for lifestyle changes.
WHAT IS THE AMERICAN MEDICAL ASSOCIATION DOING TO HELP PEOPLE WITH HIGH BLOOD PRESSURE?
The American Medical Association along with the American Heart Association and the Ad Council are raising awareness about high blood pressure for all adults in the U.S. by launching a new Public Service Awareness campaign that reminds viewers of the serious, life-threatening consequences of uncontrolled high blood pressure and that they should take urgent action by speaking with their doctor to create or modify their treatment plan together.
Viewers are directed to create or update their plan with their doctor and to visit LowerYourHBP.org for resources on how to understand your blood pressure numbers and the risks of high blood pressure sources to manage their plan. You can also download a printable worksheet that provides a structure of what to do before, during, and after an appointment with your doctor to help you create a personalized high blood pressure treatment plan
The AMA is also working with physicians and healthcare teams to prioritize blood pressure control across the U.S. through a joint initiative with the American Heart Association called Target: BP. Target: BP offers blood pressure improvement tools, resources, and expert staff to help medical offices, health centers, and healthcare organizations improve their skills, and also provides them with resources to help the patients they serve. So we are working with both patients and their doctors to try to get high blood pressure under control.
Dr. Rakotz answers your questions on the next page.