The Bad News About Prevalence, the Good News About Treatments -- But Pay Attention to the Details

Linda Brookes, MSc


February 14, 2005

In This Article


From a global perspective , researchers at the University of Tulane (New Orleans, Louisiana) have estimated that by 2025, over 29% of all adults worldwide will have hypertension . Furthermore, they caution that their prediction, based on data from 2000, is a conservative one and that the real figure for 2025 could turn out to be higher.

More locally , several studies published in January address the prevalence, treatment, and control of hypertension by race . A CDC analysis of 4 years' data from NHANES highlights racial and ethnic disparities in prevalence, treatment, and control of hypertension in the United States. The prevalence of hypertension is higher in non-Hispanic blacks in the United States compared with the US population overall. However, an international study has concluded that there is wide variation in hypertension prevalence among both black and white populations, and the rates among blacks are not unusually high when viewed internationally. The investigators believe that the impact of environmental factors on blood pressure in black populations is often overlooked in favor of seeking explanations based on genetics.

Several dietary studies with public health implications were published in January. Dietary supplementation with fiber was shown to have a small blood pressure-lowering effect, which could aid in prevention of hypertension, especially as most people in the West consume insufficient fiber. The beneficial effects on blood pressure of a diet rich in fruit, vegetables, and dairy products, first shown in adults in the DASH study , have now been confirmed in children , in a study showing that this diet is associated with smaller increases in SBP and DBP during childhood. A study showing the blood pressure benefits of folic supplementation in women of childbearing age , first presented last year, has now been published in JAMA .

Cardiovascular risk factors of hypertension, hypercholesterolemia, diabetes, and smoking in middle age may also significantly increase the risk of dementia in late life , according to the results of a study by California researchers published in Neurology . A separate study reported in the same journal suggests one way in which blood pressure may be related to the development of Alzheimer's disease .

The latest Canadian hypertension guidelines call for faster diagnosis and treatment . Currently, diagnosis can take up to 5 months before treatment is started. There has been a call to abandon the terms "hypertension" and "hypercholesterolemia" from the clinical vocabulary and, instead, treat patients based on estimated absolute cardiovascular risk. In fact, according to Prof. Rod Jackson (New Zealand), quantitative cardiovascular risk/benefit assessment should be routine for all middle-aged and elderly people. Not unexpectedly, he favors treatment with a "drug cocktail" such as a polypill for most of these individuals.

Drug news comes in the form of an announcement of successful phase 3 results with a first-in-class renin inhibitor, aliskiren, which is being developed as an antihypertensive and could become available as early as 2006. Concern over the cardiovascular effects of COX-2 inhibitors has extended to patients with hypertension. A new study shows that unlike rofecoxib, which was withdrawn from markets worldwide last year, celecoxib and the NSAID naproxen do not significantly increase 24-hour SBP in patients with hypertension, osteoarthritis, and type 2 diabetes.


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