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In the realm of cardiovascular health, uncontrolled hypertension remains a formidable adversary, often referred to as the “silent killer.” This condition, marked by persistently high blood pressure, continues to be a leading cause of premature death and disability both in the United States and globally. Cardiovascular diseases, predominantly heart attacks and strokes, account for over 900,000 deaths annually in the U.S. and approximately 10 million deaths worldwide.
A recent commentary in The American Journal of Medicine by researchers from Florida Atlantic University’s Schmidt College of Medicine underscores the persistent and escalating threat of uncontrolled hypertension. The study highlights that despite advances in awareness and treatment, this condition remains prevalent and dangerous.
Dr. Stacy Rubin, senior author of the commentary and an assistant professor of medicine at FAU Schmidt College of Medicine, emphasizes the critical role of healthcare providers in addressing uncontrolled hypertension. “Health providers should be aware that uncontrolled hypertension is one of the most common, serious, and increasing conditions among their patients,” Rubin warns. “Immediate action is crucial, as sudden cardiac death represents 50% of deaths from cardiovascular disease, with about 25% of these cases being the first symptomatic event. Additionally, 76% of stroke patients present with the stroke as their initial symptom.”
Historical data from the Hypertension Detection and Follow-Up Program, a pivotal study from the 1970s, reveals that only 50% of patients were aware of their high blood pressure, and of those, just 50% received active treatment, with only 50% of that group achieving effective control. Today, approximately 54% of individuals are aware of their high blood pressure, 40% receive active treatment, and 21% achieve effective control. Current guidelines recommend a systolic blood pressure of 130 mmHg or less and a diastolic blood pressure of 80 mmHg or less for optimal health.
Dr. Panagiota “Yiota” Kitsantas, co-author of the commentary, notes that with these updated definitions, nearly 45% of U.S. adults are affected by hypertension. The commentary also addresses the challenge of metabolic syndrome—a cluster of conditions including central adiposity, high triglycerides, low HDL cholesterol, elevated fasting blood glucose, and hypertension. Metabolic syndrome is a significant risk factor for heart attacks and strokes, particularly in the U.S., the nation with the highest rates of obesity.
Dr. Charles H. Hennekens, co-author and corresponding author of the commentary, advocates for the use of angiotensin-converting enzyme (ACE) inhibitors or their next-generation counterparts, receptor blockers, as first-line treatments for patients with metabolic syndrome. These medications have proven benefits in reducing the risk of heart attacks, strokes, and kidney disease.
Lifestyle modifications, including weight loss, increased physical activity, and reduced salt intake, are fundamental for managing hypertension. For those with blood pressure consistently above 130/80 mmHg, a combination of lifestyle changes and medications is recommended, with medications typically initiated if blood pressure remains above 140/90 mmHg despite lifestyle interventions.
The commentary also emphasizes the importance of monitoring blood pressure variability throughout the day. Health providers are encouraged to use algorithms tailored to individual patient needs and advise patients to monitor their blood pressure at home using recommended devices such as the Omron blood monitor. Dr. Hennekens advises patients to take readings each morning and night, adjusting medication dosages based on the average of multiple readings.
“While uncontrolled hypertension remains a significant global health challenge, vigilant management and adherence to these guidelines can help mitigate its impact and potentially ‘kill the old silent killer,'” concludes Dr. Hennekens.
The commentary is a collaborative effort including contributions from Barry R. Davis, M.D., Ph.D., of the University of Texas — Houston School of Public Health; Jared Greenwald, a pre-medical student; John Dunn and Alexandra Matarazzo, second-year medical students at FAU; and Katerina Benson, a pre-medical student at FAU. The study underscores the ongoing need for heightened awareness and proactive management of hypertension to combat its dangerous effects.
