Successful Approaches to Reduce Hypertension

1. Successful Approaches to Reduce Hypertension Stephen Sidney, MD, MPH Kaiser Permanente Northern California October 17, 2012

2. Basic Facts - Hypertension • Hypertension causes acute myocardial infarctions, stroke, heart failure and chronic kidney disease. • 67 million adults in the United States have hypertension (30.4%) • More than than half of adults (35.8 million) with hypertension are uncontrolled (53.5%). • Less than half of adults (16 million) with uncontrolled hypertension are aware that they have hypertension and are treated for it (44.7%)

3. Hypertension - Disparities • Blacks have higher rates of hypertension than whites (39% vs 32%) and higher rates of uncontrolled hypertension (57% vs 52%). • Rate of uncontrolled hypertension even higher in Hispanics (63%) • Younger adults have higher rates of uncontrolled hypertension than older adults (62% for age 18-44 years vs. 51% for age >45 years).

4. Hypertension in Blacks • Compared with whites, hypertension in Blacks is: • more frequent • occurs earlier in life • more severe • more often associated cardiovascular complications • 1% of blacks develop heart failure by age 50 years vs. <0.1% of whites • 1% of blacks develop strokes by age 55 years vs. 0.3% of whites.

5. Ischemic stroke incidence rates in younger adults (ages 25-44 years), 2000-2008

6. So . . . • Hypertension is a an enormous public health problem. • Hypertension control rates are relatively low, especially in younger people and there are significant race/ethnicity disparities. • It would be reasonable to start thinking of hypertension in younger African Americans as a public health emergency. • But we can do better.