PARIS, February 4 /PRNewswire/ -- A Working Group of representatives from seven international health-care organizations call for improved blood pressure (BP) goal rate levels of patients with hypertension, the single most important cause of attributable mortality around the world. This has driven the working group to identify 5 specific concrete practical actions which are described in the January 2008 issue of the Journal of Human Hypertension(1): Detect and Prevent high BP; Assess total cardiovascular risk; Form an active partnership with the patient; Treat hypertension to goal; Create a supportive environment.
According to George Bakris, Director of the Department of Medicine, Hypertensive Diseases Center, University of Chicago School of Medicine, Chicago, USA and Steering Committee Member of the Call to Action Working Group, "these actions, if rigorously implemented by practitioners and targeted health-care systems throughout the world, should help to close the gap between our therapeutic capabilities and health-care delivery and thereby save millions of lives."
Hypertension is a silent killer which still affects over one billion people worldwide(2),(3). This number is expected to grow to 1.5 billion by 2025(3), causing millions of people to die prematurely or suffer irreversible health consequences including strokes, myocardial infarction, heart failure or kidney disease, mainly because they are not being treated to BP goal. Despite the availability of effective treatments, 75% of the overall hypertensive patients' population and even 50% of the patients treated are not at the recommended goal of 140/90 mm Hg or below(4),(5),(6). Non-adherence of patients to prescribed medication is a challenge in all chronic conditions with only 50% of patients compliant to drugs and about 10% to lifestyle changes in the US(7).
"Health-care professionals should therefore be urged to keep in mind that, even if patients feel good, it is not sufficient to merely bring them close to the goal, instead of at goal or below", said Ernesto Schiffrin, Physician-in-Chief and Chair, Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Canada and member of the Call to Action Working Group. Lifestyle changes are not only important because of the positive impact they can have on blood pressure management, but also for economic reasons related to the considerable cost savings that can be obtained when patients learn how to adhere to them on a regular basis. This is a specific area where the close relationship of nurses with patients can have a strong influence. "Through our partnering with patients and their families, we have found that we can develop a greater understanding for the importance of physical exercise and better eating habits on the disease evolution process, as well as provide tips to concerned patients on how they may integrate better lifestyle measures into their daily lives" said Amy Coenen, International Council of Nurses, University of Wisconsin College of Nursing, Milwaukee, WI, USA.
The first core action aims at detecting and treating more patients who have dangerous levels of BP but are not being treated or are not at their pressure goal (140/90 mm Hg or 130/80 for patients with risk factors). For every 20/10mm Hg rise in BP above this level, the risk of death from cardiovascular problems doubles(8). Those at greatest risk of a fatal event include middle-aged, elderly, overweight or diabetic individuals. Their additional cardiovascular risk factors should be thoroughly and rapidly assessed as part of the second core action in order to prevent severe target organ damage, such as advanced or end stage kidney disease. In the third core action, because too many patients are not at their targeted BP goal, the group has suggested the creation of a partnership with the patient. The objective is to motivate patients to play a more active role in the management of their disease and allow them to track their progress. The fourth core action concerns the treatment goal - perhaps the most difficult but highly important action. Physicians and health-care providers are urged to explain the importance of adopting long-term lifestyle measures to their patients. If insufficient, they must offer adequate, rigorous drug therapy to bring them rapidly to the 140/90 mm Hg goal or lower in high risk patients. For patients who are a certain way from their desired goal, recent studies confirm that appropriate combination medications could be given right from the start.
"In addition to proper education on diet and lifestyle measures, prescribing therapies that patients tolerate well, can afford and take once-a-day are ways in which physicians can improve compliance" said Trefor Morgan, Director of the Department of Physiology, University of Melbourne, Victoria, Australia and member of the Call to Action Working Group, on behalf of the Asian-Pacific Society of Hypertension.
The fifth and final step in this Call to Action seeks general support from the patient's surrounding environment, like community organizations or local institutions, to endorse the necessary preventive strategies and screening.
"There is no "one size fits all" and you cannot achieve good results without the patient" said Giuseppe Mancia, Director of the Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy and Steering Committee member of the Call to Action Working Group.
Luis Miguel Ruilope, President of the Spanish Society of Hypertension and member of the Call to Action Working Group said "By encouraging health-care providers to think of a hand and its five fingers for each of the 5 core actions representing the most relevant actions directed at counteracting high BP, we could significantly impact the lives of millions of people around the world and better prevent the painful consequences of uncontrolled hypertension."
Call to Action Working Group
This release is endorsed by the following experts: G Bakris, International Society of Nephrology, Department of Medicine, Hypertensive Diseases Center, University of Chicago, Pritzker School of Medicine, Chicago, Il, USA; M Hill, The Johns Hopkins University of School of Nursing, Baltimore, MD, USA; G Mancia, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy; K Steyn, Chronic Diseases of Lifestyle Unit, Medical Research Council, Cape Town, South Africa; T Pickering, Behavioral Cardiovascular Health and Hypertension Program, Columbia Presbyterian Medical Center, New York, NY, USA; S De Geest, Institute of Nursing Science, University of Basel, Switzerland; L Ruilope, Spanish Society of Hypertension, Department of Medicine, Hypertension Unit, 12 de Octubre Hospital, Madrid, Spain; T Morgan, Asia Pacific Society of Hypertension, Department of Physiology, University of Melbourne, Victoria, Australia; S Kjeldsen, Department of Cardiology, Ullevaal University Hospital, Oslo, Norway; EL Schiffrin, Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montréal, Canada; A Coenen, International Council of Nurses, University of Wisconsin College of Nursing, Milwaukee, WI, USA; P Mulrow, Department of Medicine, Ruppert Health Center, Medical University of Ohio, Toledo, OH, USA; A Loh, WONCA, Department of Family Medicine, College of Medicine Building, Singapore, Singapore; GA Mensah, World Heart Federation,Geneva, Switzerland.
Other members of the Call to Action Working Group include HR Black, Department of Nephrology, New York University School of Medicine, New York, NY, USA; TD Giles, American Society of Hypertension, Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA.
Their initiative was supported by an educational grant from Bristol Myers-Squibb and sanofi-aventis.
(1) Bakris G et al. Achieving blood pressure goals globally: five core actions for health-care professionals. A worldwide call to action. J Human Hypertens, 2008; 22: 63-70
(2) Hajjar I et al. Hypertension: trends in prevalence, incidence, and control. Annu Rev Public Health 2006; 27: 465-90
(3) Kearney PM et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217-23
(4) Pavlik VN, Hyman DJ. How well are we managing and monitoring high blood pressure? Curr Opin Nephrol Hypertens 2003; 12: 299-304
(5) Waeber B et al. Compliance with antihypertensive therapy. Clin Exp Hypertens 1999; 21: 973-85
(6) Berlowitz DR et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1957-63
(7) Haynes RB et al. Helping patients follow prescribed treatment: clinical applications. JAMA 2002; 288: 2880-3
(8) Lewington S, et al. Age-specific relevance of usual blood pressure to vascular mortality. Lancet 2002; 360: 1903-13
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