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Health Spotlight
Hypertension
Blood pressure is the force of blood against the walls of the body's arteries. When someone suffers from hypertension, his or her blood vessels become narrower, forcing the heart to pump harder to move blood through the body. When it stays elevated over time, an individual is experiencing high blood pressure, also known as hypertension. This condition is dangerous because it can lead to atherosclerosis (hardening of the arteries), and also can increase the risk of heart disease and stroke.1
Hypertension is often called the silent killer because it has no signs or symptoms. In addition to heart disease and stroke, other effects of uncontrolled high blood pressure include impaired vision, kidney damage, heart attack, and congestive heart failure.2
Blood pressure measurement
Blood pressure is recorded as two numbers-the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). The measurement is written one above or before the other, with the systolic number on top and the diastolic number on the bottom - for example, 120/80 mmHg, and stated 120 over 80.
What is normal?
A blood pressure reading below 120/80 is considered normal. In general, lower is better, but very low blood pressure also could be cause for concern. A blood pressure of between 120/80 mmHg and 139/89 mmHg is considered prehypertension. This means that you do not have high blood pressure now but may develop it in the future. A reading of higher than 140/90 is considered to be high blood pressure.
When systolic and diastolic blood pressures fall into different categories, the higher category should be used to classify blood pressure level. For example, 160/80 would be considered high blood pressure.3
Prevalence
High blood pressure is very prevalent among Americans.4
- As many as 65 million Americans age 6 and older have high blood pressure,
- Nearly one in three U.S. adults has high blood pressure,
- More than 40 percent of African Americans have high blood pressure, and
- Thirty percent of people with high blood pressure don't know they have it.
Among veterans,
- Hypertension is the most commonly reported medical problem and is a major risk factor for heart disease and stroke, and
- Most VA patients don't meet the target blood pressure guidelines set by evidence-based clinical practice guidelines.5
Hypertension risks and warning signs
Hypertension has no identifiable cause, but controllable risk factors may include: genetics, obesity, eating too much salt, drinking too much alcohol, stress, and lack of physical activity. Uncontrollable risk factors can include: race (e.g., blacks develop high blood pressure more often than whites), heredity, and age (older people are at greater risk for high blood pressure).
Secondary hypertension is caused by other complications, which can include kidney disorders and adrenal gland tumors.
Usually, hypertension has no symptoms. However, individuals who experience severe headaches, vision changes, nosebleeds, irregular heartbeats, or ear noise or buzzing should consult a health care professional as they could be warning signs of high blood pressure.6
Prevention/Treatment
Hypertension is a lifelong disease that can usually be controlled, but not cured. By managing it and starting a treatment program, maintaining a lower blood pressure is easier. Those suffering from hypertension should work with their doctor to determine the best treatment, which could include dietary changes to reduce fat (particularly saturated fat), eating less salt, and increasing regular physical activity. Quitting smoking and monitoring alcohol intake also are ways to reduce risk. Additionally, many medications can help reduce and control high blood pressure.7
Research/Studies
HSR&D has numerous ongoing studies and important research that focuses on improving the health of veterans with hypertension. Highlighted below are a few of these studies.
Hypertension management group visits
This project's goal is to improve evidence-based treatment for hypertension through group medical visits. Patients with hypertension receive medical care in a group setting designed to promote effective self-management of the disorder in accordance with a recommended regimen of diet, exercise and medication. Researchers will analyze changes in patients' blood pressures and medication adherence by comparing a control group to those attending group medical appointments. Results of the study will provide information on establishing group visits, and will contribute to understanding the potential for this quality improvement strategy as a means to implement evidence-based guidelines for chronic disease care.5
Evidence-based hypertension treatment
Despite hypertension's frequency and treatability, less than 40% of patients are adequately treated for the disorder. The goal of this project is to develop an innovative intervention to improve the blood pressure control of VA primary care patients with hypertension. The research is based on the results of patient surveys completed in face-to-face interviews and provider surveys sent by mail. The results of the surveys are expected to help inform the design of a randomized-controlled clinical intervention to be used throughout the VA, and also for other diseases. Additionally, the findings will help inform policymakers and clinical leadership of the barriers that exist in hypertension management.8
Guidelines for drug therapy of hypertension
This study's objective was to contribute to the VA's ability to respond flexibly to rapidly evolving medical knowledge by establishing a system for implementing clinical practice guidelines that can be used throughout the VA nationally. Researchers established the feasibility of deploying the ATHENA DSS automated decision support system that provides recommendations for management of chronic disease, based on complex reasoning, in actual geographically diverse VA primary care clinics. Over the 15-month period, the study displayed advisories to clinicians for approximately 10,000 distinct patients with hypertension. The study showed that such systems can potentially improve guideline concordance of clinical practice and the technology used can also be used to develop automated decision support in other clinical domains.9
Addressing translation barriers to hypertension treatment
Even though the prevalence of hypertension among individuals with type 2 diabetes is high, clinicians often fail to increase medication dosages or start new medications even when necessary. Researchers are trying to design appropriate quality improvement (QI) interventions that address important barriers and facilitators to translation for high-risk patients with hypertension, such as veterans who have diabetes. This study is the first multi-site evaluation of translation barriers to hypertension research and is expected to serve as a model for understanding barriers to translation in other conditions, both within and outside the VA.10
Using automated data to assess quality of hypertension care
Improving hypertension requires ongoing assessment, and unadjusted blood pressure control is the only widely used measure for such an assessment. This study compares the availability and agreement of blood pressure measurements from two sources-VA's computerized patient record system (CPRS) and clinicians' notes. Results show that CPRS alone with automated data plus clinical notes did not significantly change the number of patients with controlled blood pressure. Further, investigators found that most BP data were available in an automated form in the vital signs file of the VA's CPRS and that most medical visits had only one BP measurement available regardless of source. Thus, given the demonstrated completeness of automated BP data in the electronic record, they suggest assessments of hypertension care can be made based on these data alone, making such evaluations more efficient. Where effective databases do not currently exist, the VA's vital signs file is a prototypical clinical computerized data system that could be easily adopted by other settings. 11
Resources
1. What are High Blood Pressure and Prehypertension? National Heart, Lung, and Blood Institute.
2. What is High Blood Pressure and Why is it So Dangerous? The National Women's Health Information Center.
3. High Blood Pressure. National Heart, Lung, and Blood Institute.
4. High Blood Pressure Statistics. American Heart Association.
5. Group visits to improve hypertension management. HSR&D study TRH 01-173; Principal Investigator, Mary K. Goldstein, MD VA Palo Alto Health Care System.
6. Hypertension. Medline Plus.
7. What Can I Do? American Heart Association.
8. Implementing evidence based treatment of hypertension. HSR&D study IMV 04-066; Principal Investigator Peter J. Kaboli, MD, MS VA Medical Center, Iowa City.
9. Guidelines for drug therapy of hypertension: Multi-site implementation. HSR&D study CPI 99-275; Principal Investigator, Mary K. Goldstein, MD VA Palo Alto Health Care System.
10. Addressing barriers to translation for treatment of hypertension. HSR&D study IIR 02-225; Principal Investigator, Eve A. Kerr, MD, MPH VA Ann Arbor Healthcare System.
11. Borzecki A, Wong A, Hickey E, et al. Can we use automated data to assess quality of hypertension care? American Journal of Managed Care July 2004; 10:473-9.
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