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Massive Campaign Begins to Control High Blood
Pressure
Two of every three senior citizens has
hypertension
Feb. 2, 2006 A massive campaign to improve
Americans' control of high blood pressure his kicked off with a $3.7
million dollar budget and 150 physicians trained to carry the message to
other doctors nationwide. Hypertension strikes two-thirds of senior
citizens (65 and older). Americans who reach age 55 without the disease
have a 90 percent chance of developing it before they die.
Researchers in the largest high blood pressure
clinical trial ever conducted are launching this comprehensive outreach
program to improve high blood pressure control across America.
The participating physicians are in 34 states and
Washington, DC. Their goal: to help doctors and patients prevent and
better treat high blood pressure.
The three-year educational effort is a follow-up to
the landmark Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial (ALLHAT) and is being implemented in collaboration
with the National High Blood Pressure Education Program (NHBPEP). Funded
by the National Heart, Lung, and Blood Institute (NHLBI), part of the
National Institutes of Health, the ALLHAT blood pressure study compared
the effects of four major classes of medications to treat high blood
pressure.
More than 42,000 patients ages 55 and older
participated. The main results were published in the
Journal of the American Medical
Association in December 2002 and played a central role in
NHBPEP's revision of the clinical practice guidelines on high blood
pressure released in May 2003 (Seventh
Report of the Joint National Committee on the Prevention, Detection,
Evaluation and Treatment of High Blood Pressure).
"It often takes years for the results of major
studies to become part of standard health care," notes NHLBI director
Elizabeth G. Nabel, MD.
"The results of ALLHAT and the clinical guidelines
could have an enormous impact on the health of millions of Americans. We
are confident that by playing a more active role in sharing the
information, we will be able to put the results into action more quickly
and more effectively."
An estimated 65 million American adults nearly
one in three have high blood pressure. But, for more than two-thirds
of them, blood pressure remains out of control.
High blood pressure leads to more than half of all
heart attacks, strokes, and heart failure cases in the United States
each year, and it increases the risk of kidney failure and blindness.
Clinical guidelines recommend that physicians work
with patients to keep blood pressures below 140/90 mmHg, even lower for
people with diabetes or kidney disease, and encourage all their patients
to make healthy lifestyle changes.
Lifestyle Changes
Lifestyle changes cited include:
● losing excess weight,
● becoming physically active,
● limiting alcoholic beverages,
● following a heart-healthy eating plan, including cutting back on
salt and other forms of sodium, and
● not smoking.
Diuretics Recommended
ALLHAT researchers reported in 2002 that, overall,
diuretics are more beneficial than calcium channel blockers, angiotensin
converting enzyme (ACE) inhibitors, or alpha blockers as initial
treatment to lower blood pressure and to protect against adverse effects
of high blood pressure.
For patients with diabetes or with mildly elevated
fasting glucose a sign of pre-diabetes diuretics are at least as
effective, and in some cases more beneficial, than the other two classes
of medications, according to ALLHAT findings published in June 2005.
In general, diuretics are well tolerated by
patients, with few side effects. Sometimes called "water pills,"
diuretics reduce the amount of fluid in the body by helping the kidneys
flush excess water and salt from the body.
The other medications lower blood pressure
differently.
● Calcium channel blockers keep calcium from
entering the muscle cells of the heart and blood vessels, causing the
blood vessels to relax.
● ACE inhibitors prevent the formation of a
hormone called angiotensin II, which normally causes blood vessels to
narrow. Alpha blockers allow blood to pass more easily by reducing nerve
impulses to blood vessels. However, ALLHAT found that participants
taking alpha blockers had 25 percent more cardiovascular events and were
twice as likely to be hospitalized for heart failure as those taking the
diuretic. Because of these findings, the alpha blocker arm of the study
was stopped early.
Based on the results, the ALLHAT investigators
recommend that in addition to lifestyle changes, diuretics should be the
drug of choice for first line blood pressure treatment, says William C.
Cushman, MD, chair of the ALLHAT Dissemination Committee and chief of
Preventive Medicine at the Veterans Affairs Medical Center in Memphis.
Because most patients require more than one drug,
diuretics should generally be part of any antihypertensive regimen.
Cushman cites another advantage for using
diuretics. They are much less expensive than the other two drug
classes. For those stretching their budgets, taking a medicine which
costs less than $100 a year is a very good thing.
In the past 20 years, however, prescriptions for
newer, more costly medications began replacing diuretics. The newer
drugs were shown to lower blood pressure and heart disease risk compared
to placebo, but how the drugs compared to each other was unknown until
ALLHAT. Analyses of prescribing trends suggest that prescriptions for
diuretics have slowly begun to rise since the study ended and clinical
guidelines have encouraged the use of diuretics either alone or in
combination with other blood-pressure lowering medications.
"The guidelines were simplified and strengthened to
emphasize the most effective ways to control blood pressure starting
with lifestyle changes and including diuretics when medication is
needed," notes Jeffrey Cutler, MD, NHLBI senior advisor and ALLHAT
project director.
The ALLHAT Dissemination Plan includes materials
for investigator educators to lead small, interactive educational
sessions with physician peers. Educators are asked to make at least one
presentation per month. The sessions include discussions of the study
results, current hypertension treatment guidelines, and common concerns
in clinical practice. Each educator receives training, presentation
slides and handouts, and materials such as posters and brochures for
clinicians to use in their offices. The educators expect to reach nearly
30,000 physicians by September 2006.
The dissemination plan also provides materials to
encourage patients to ask their health care providers about their blood
pressure control and the medicines they take. Brochures, recipe books,
and other tools to help patients adapt healthier lifestyles are also
available.
Resources:
● Antihypertensive and Lipid-Lowering Treatment
to Prevent Heart Attack Trial (ALLHAT),
http://www.nhlbi.nih.gov/health/allhat/index.htm
● "Your Guide to Lowering High Blood Pressure,"
National Heart, Lung and Blood Insistute. http://www.nhlbi.nih.gov/hbp/index.html
● Hypertension guidelines: Seventh Report of the
Joint National Committee on the Prevention, Detection, Evaluation and
Treatment of High Blood Pressure,
http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm
● Public and patient information: Your Guide to
Lowering High Blood Pressure,
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm
● Public health tools and information: Prevent
and Control High Blood Pressure: Mission Possible,
http://hin.nhlbi.nih.gov/mission/
NHLBI is part
of the National Institutes of Health (NIH), the Federal Governments
primary agency for biomedical and behavioral research. NIH is a
component of the U.S. Department of Health and Human Services. NHLBI
press releases and other materials including information about high
blood pressure are available online at
www.nhlbi.nih.gov.
The National Institutes of Health (NIH) The
Nation's Medical Research Agency includes 27 Institutes and Centers
and is a component of the U. S. Department of Health and Human Services.
It is the primary Federal agency for conducting and supporting basic,
clinical, and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
http://www.nih.gov.
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