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Summer 2010 Vol. 10 Number 2

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Under Pressure

Getting a Handle on Hypertension

If you don't have high blood pressure, you probably know someone who does. Chronic hypertension is so common among Americans -- in part because of the high salt content of our diets -- that it is becoming an almost expected aspect of getting older. Many people bear the condition for years without significant ill effects, but hypertension can trigger heart attacks, kidney failure, and debilitating strokes.

Many individuals know that their blood pressure level matters, and most have heard that too much salt is unhealthy. Doctors counsel their patients to maintain a healthy blood pressure and watch their sodium intakes, among other strategies for good health. Why then hasn't this awareness translated into healthier eating habits and lower rates of hypertension? Two new reports from the Institute of Medicine recommend strategies to tackle these stubborn problems.

People need help to take steps to avoid hypertension and keep it under control, said the committee that wrote A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. American society too often makes unhealthy options the easy choices. Increased physical activity, lowered sodium consumption, and policies that create environments which support healthier eating offer greater promise of addressing hypertension than merely educating individuals about the dangers of high blood pressure, the committee said.

The hypertension rate might be reduced by as much as 22 percent if Americans consumed less salt and ate more vegetables, fruit, and lean protein, the committee estimated. An exercise program that gets physically inactive people moving could decrease prevalence by 4 percent to 6 percent.

Physicians' lax adherence to guidelines for treating hypertension is another significant reason why many patients are unaware of their condition and don't have it under control. Medical and public health groups should undertake studies to determine why many doctors fail to follow the recommended protocol.

Excess salt is widely recognized as one of hypertension's major causes. A recent study calculated that reducing Americans' average daily sodium consumption to the currently advised maximum of 2,300 milligrams could bring down the number of individuals with high blood pressure by about 11.1 million.

But because salt is so widespread in the foods that make up the typical American diet, public education campaigns have failed to make a dent in Americans' excessive consumption of this ingredient. Likewise, the food industry's voluntary efforts to reduce sodium have fallen short because companies fear losing customers to competitors who make products with higher salt content, and with so many salty options available, people's taste preferences cannot easily change.

Given these realities, new federal standards for the amount of salt that food manufacturers, restaurants, and food service companies can add to their products are required to bring people's sodium intakes down to safe levels, says Strategies to Reduce Sodium Intake in the United States. The Food and Drug Administration should gradually step down the maximum amount of salt that can be added to foods and meals through a series of incremental reductions, concluded the authoring committee.

The goal is to bring the amount of sodium in Americans' diets below levels associated with the risk of illness in a gradual way that assures food will still taste good. Because the majority of people's sodium intake comes from salt that companies put into prepared meals and processed foods -- not from what individuals add with the salt shaker -- this regulatory strategy would make it easier for consumers who want to avoid excess salt to succeed.

Making it simpler for Americans to make healthy choices is easier said than done. But experience shows it is necessary to help the nation finally reverse its upward hypertension rate. --  Christine Stencel

A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Committee on Public Health Priorities to Reduce and Control Hypertension in the U.S. Population, Board on Population Health and Public Health Practice, Institute of Medicine (2010, 236 pp.; ISBN 0-309-14809-X). The committee was chaired by David Fleming, director and health officer, Public Health --Seattle/King County, Seattle. The study was funded by the U.S. Centers for Disease Control and Prevention.

Strategies to Reduce Sodium Intake in the United States. Committee on Strategies to Reduce Sodium Intake, Food and Nutrition Board, Institute of Medicine (2010, approx. 480 pp.; ISBN 0-309-14805-7). The committee was chaired by Jane E. Henney, professor of medicine, University of Cincinnati College of Medicine, Cincinnati. The study was funded by the U.S. Centers for Disease Control and Prevention; U.S. Food and Drug Administration; National Heart, Lung, and Blood Institute; and the U.S. Department of Health and Human Services' Office of Disease Prevention and Health Promotion.

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Copyright 2010 by the National Academy of Sciences