麻豆传媒

Hypertension control is a national public health priority that should not take a back seat to COVID-19, declared U.S. Surgeon General Jerome Adams, MD, MPH.

Adams is leading an initiative, summarized in a document titled ," by the Department of Health and Human Services (HHS) intended to ensure that communities nationwide support hypertension control and to optimize patient care to achieve it.

Adams promoted self-monitoring of blood pressure (BP) as an integral component of patient care. "We need people to know their numbers," Adams said.

Current guidelines recommend out-of-office BP monitoring to avoid white coat or . The American Heart Association (AHA) and American Medical Association (AMA) recently emphasizing the established clinical benefits and potential cost-effectiveness of self-measured BP (SMBP) over office BP.

"To ensure access to BP monitoring for those who would considerably benefit from it, we urge the Centers for Medicare and Medicaid Services and other insurance providers to include coverage of SMBP devices for treatment and management of hypertension," said AHA CEO Nancy Brown in a .

Both Adams and HHS Secretary Alex Azar displayed their personal home BP monitors during an HHS press conference.

Yet not all BP monitors are alike, as many unvalidated models are freely available on the market.

Thus, it is "vital for patients and health care professionals to understand which BP measurement devices have been validated for accuracy, which is why we supported the launch of the first-ever earlier this year," said AMA president Susan Bailey, MD, in a .

"Some may question the release of this report now, when the challenge of SARS-CoV-2 has become the most pressing health priority in the U.S. However, it is precisely the effects of the pandemic, and the painful lessons that are being learned, that add even greater urgency to improving hypertension control rates for all U.S. adults," according to a JAMA viewpoint article by Adams and Janet Wright, MD, director of science and policy in the Office of the Surgeon General.

They noted that the same socioeconomic factors affecting COVID-19 infection risk and outcomes also play a role in BP control.

HHS reset national public health goals in August to place greater emphasis on social determinants of health and quality of life.

Also adding to the urgency of BP control are signs that hypertension control in the U.S. is slipping.

"After years of improvement, overall rates of blood pressure control have declined in recent years, with rates in 2017-2018 matching those of 2005-2006," according to Brown's statement.

Yet "there is no excuse not to have hypertension under control," Adams said, citing low-cost generic medications and healthy habits that don't require money.

It got personal for Adams, who noted that he himself has high BP.

"I was diagnosed with high blood pressure at a young age. I lost all four grandparents to disease exacerbated by hypertension: one stroke, one heart attack, and both of my grandmothers to dementia. My mother is still recovering from a stroke she suffered this year," he said.

Since 2017, U.S. cardiology societies have recommended 130/80 mm Hg as the target BP for the general population. The lowering of the threshold had been met with sharp criticism by the American College of Physicians and others.

Comment