Race and Medicine
Race and Medicine
Source/Disclosures
Source:

Office of the Surgeon General. The Surgeon General’s Call to Action to Control Hypertension. Available at: www.hhs.gov/sites/default/files/call-to-action-to-control-hypertension.pdf. Accessed Oct. 7, 2020.

Disclosures: Adams is the U.S. surgeon general. Bailey is president of the American Medical Association. Brown is CEO of the AHA. Wright reports no relevant financial disclosures.
October 07, 2020
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Surgeon general: Hypertension control must be national public health priority

Source/Disclosures
Source:

Office of the Surgeon General. The Surgeon General’s Call to Action to Control Hypertension. Available at: www.hhs.gov/sites/default/files/call-to-action-to-control-hypertension.pdf. Accessed Oct. 7, 2020.

Disclosures: Adams is the U.S. surgeon general. Bailey is president of the American Medical Association. Brown is CEO of the AHA. Wright reports no relevant financial disclosures.
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The Office of the Surgeon General released a report highlighting the importance of hypertension control as a national public health priority.

Jerome M. Adams

Nearly half of U.S. adults — 108 million — have hypertension, yet only 1 in 4 people have it under control, U.S. Surgeon General Jerome M. Adams, MD, MPH, said during the release of a call to action by HHS.

blood pressure being taken
Source: Adobe Stock.

The call to action, are available on the website of HHS, includes three goals:

  • Establish hypertension control as a national public health priority.
  • Build and sustain communities that help individuals control high BP.
  • Optimize patient care to control hypertension.

In the HHS video release, Adams said the COVID-19 pandemic is an issue on the minds of many, but focus should continue to be on hypertension control.

“I don’t want us to ever forget the tragedy of over 200,000 people who have died due to COVID-19,” Adams said. “We must keep our eyes on that ball ... but I also don’t want us to turn a blind eye to the more than 500,000 people who will die this year due to uncontrolled high blood pressure. While we’re still looking for vaccines and therapeutics to treat COVID, I want you to know we have the tools already to end our national epidemic of uncontrolled hypertension.”

Timing of call to action

Adams said the COVID-19 pandemic served as a catalyst for this document, especially since it has affected several subsets of the population.

“The COVID-19 pandemic has affected us all, but it has hit subsets of our population especially hard,” Adams said during release of the document. “People of color and older Americans are more likely to have both medical conditions and social preexisting conditions that decrease the resilience in general and raise the likelihood of more severe complications and death from COVID-19.”

Adams added that hypertension and the social factors that lead to it are one example, especially since, compared with white patients, Black patients are more likely to have hypertension, to have lower rates of control, to be diagnosed with hypertension at a younger age and to have more organ damage as a result of the diagnosis. In addition, among U.S. adults with hypertension, 80% of Hispanic and Black Americans have uncontrolled BP.

“We cannot wait, especially in communities of color, to address the U.S. epidemic of uncontrolled hypertension,” Adams said.

Another reason for the timing of this document’s release includes that progress previously made in controlling hypertension “is slipping away from us,” Adams said. Because of this, three of four Americans with hypertension, or 82 million people, are at risk for preventable events and conditions. The last reason for this document’s release focuses on the awareness of effective treatments and approaches to control hypertension.

At the end of the HHS video release, Adams said he was optimistic that obtaining greater hypertension control is a realistic goal.

“These days that often fill us with fear, uncertainty and stress, I want to close by expressing my hope and optimism, my resolve that together we can improve hypertension control,” Adams said. “In doing so, we will improve other outcomes ranging from maternal health and dementia to our resiliency to COVID-19, but achieving that goal will take action by each of us, all of us and all of you as individuals, as well as in our communities and in our health care systems.”

Importance of national commitment

Janet S. Wright

The surgeon general, in addition to Janet S. Wright, MD, executive director of Million Hearts, a national initiative co-led by the CDC and CMS, wrote a viewpoint in JAMA focused on this national commitment.

“The involvement of policymakers, payers and employers, health care and public health professionals, researchers and community leaders is critical in addressing the underlying contributing factors for hypertension and the gaps in blood pressure control and in realizing the opportunities to improve the nation’s health, resilience and prosperity,” Adams and Wright wrote. “The time for action is now. Implementing the goals and strategies in the Call to Action, together as a nation, could help patients, clinicians and communities achieve the health, wealth and equity benefits that national hypertension control can bring.”

In conjunction with this viewpoint’s publication, Howard Bauchner, MD, editor-in-chief of JAMA, hosted a live Q&A with Adams to discuss the importance of this call to action. During this session, they discussed a recent paper published in JAMA, which found that despite significant improvements in BP control among U.S. patients with hypertension between 1999 and 2013, there was an approximately 10% drop in BP control from 2013 to 2018. In addition, Paul Muntner, PhD, professor and associate dean for research in the School of Public Health at the University of Alabama at Birmingham, and colleagues found a reduced prevalence of BP control among non-Hispanic Black patients compared with non-Hispanic white patients.

“I found the Muntner article almost an indictment of the American health care system, that control had declined over the last decade, I found so disturbing,” Bauchner said during the session. “We can actually diagnose hypertension, and treatment isn’t that expensive. It’s not like a lot of other things that we do, where getting from diagnosis to treatment can be very difficult and expensive. There is a way forward.”

In response to that comment, Adams said, “We need to make sure we’re focused on the evidence-based practices out there that have allowed practices across the country — rural and urban, Black communities, white communities, rich, poor, large, small practices — have been able to achieve 80% [or higher] hypertension control.”

Adams added that the “most important aspect to this” is that treatment should not be focused just on medications, but also physical activity and diet, especially in those who may not have access to these opportunities.

“We know that two of the top things you can do to get your blood pressure under control are eating a healthy diet and being more active,” Adams said. “We also know that not everyone has an equitable opportunity to eat a healthy diet and to be more active. This is what we call social determinants of health. We talk about medical preexisting conditions, but we don’t talk enough about social preexisting conditions, transportation, child care, a job that pays a good wage, the environment, the neighborhood you live in and whether or not it’s safe to go out and be active.”

“This essential report calls critical attention to the epidemic of uncontrolled blood pressure, which puts 87 million adults nationwide at elevated risk of heart attack or stroke,” Nancy Brown, CEO of the American Heart Association, said in a press release. “We stand ready to work with Vice Admiral Adams, the Centers for Disease Control and Prevention and its National Hypertension Control Roundtable, and public health and health care providers across the country to implement this call to action and prevent countless cases of cardiovascular disease.”

In a statement from Susan R. Bailey, president of the American Medical Association, she wrote, “Our top priority is to ensure physicians and all Americans, especially those in underrepresented and under-resourced communities, have access to quality health care and the support they need to control high blood pressure and reduce the burden of cardiovascular disease. We are hopeful that today’s report will lead to more organizations and individuals recognizing that high blood pressure is a major health threat that must be addressed, spurring them to take immediate action to help protect more Americans from its deadly impact.”

References:

  • Adams JM, et al. JAMA. 2020;doi:10.1001/jama.2020.20356.
  • HHS.gov. Release: Surgeon General’s Call to Action to Control Hypertension Live Stream. Available at: www.hhs.gov/live/live-1/index.html. Accessed Oct. 7, 2020.
  • YouTube. The Surgeon General’s Call to Action to Control Hypertension. Available at: www.youtube.com/watch?v=zQI4J370iuA&feature=youtu.be. Accessed Oct. 7, 2020.