Better Blood Pressure Control: A National Priority

An Interview With CDC Director Tom Frieden

Tom Frieden, MD, MPH


November 15, 2013

Editorial Collaboration

Medscape &

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Editor’s Note:
Medscape recently interviewed Tom Frieden, MD, MPH, Director, US Centers for Disease Control and Prevention, on his specific recommendations for better identification, tracking, and treatment of people with high blood pressure. His focus is on the need to pick and use an evidence-based protocol.

Progress on the "Silent Killer"

Tom Frieden, MD, MPH: One in 3 adults in this country has high blood pressure. That's nearly 67 million people, and more than 35 million of them don't have it under control. In fact, high blood pressure contributes to more than 1000 deaths every day. We are making progress, but not nearly fast enough. Control is now increasing at about 1% per year. We need to ramp that up to 5% per year. High blood pressure control has to be a priority for every patient at every visit.

There are ways that we can make a big difference, and we are learning about that, using health information technology (IT), registries, prompts, alerts, and reports; and making every single member of the healthcare team involved -- including the patient and the pharmacist -- working together to control blood pressure.

We have launched Million Hearts to prevent 1 million heart attacks and strokes by 2017.

Medscape: Why do you believe that the United States continues to have suboptimal results in detecting and controlling high blood pressure?

Dr. Frieden: High blood pressure is a silent killer. Many patients don't realize that they have a problem. In fact, many doctors may underdiagnose high blood pressure. Perhaps the patient is there for another reason; the blood pressure is elevated, but high blood pressure is not diagnosed. In fact, we have found that people with uncontrolled hypertension have usually seen a doctor at least twice in the past year. This is the case because many times, high blood pressure is hiding in plain sight. Even though there are multiple elevated readings in the medical record, they are not detected or diagnosed, and patients are not put on treatment.

Furthermore, blood pressure can be difficult to control. It can be hard to find the right treatment or mix of drugs. The patient may not start medications, may not take medications as prescribed, or may stop medicines if they have unpleasant side effects.

Focusing on high blood pressure has to be our priority. Health IT and a team effort are key. Registries and regular check-ins can address many of the problems that lead to uncontrolled blood pressure and avoidable heart attacks and strokes.


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