Experts and Representatives From Leading International Health-Care Organizations Call to Stop the Hypertension Pandemic, a Worldwide Silent Killer

    PARIS, Feb. 4 /CNW/ - A Working Group of representatives from seven
international health-care organizations call for improved blood pressure (BP)
goal rate levels of patients with hypertension, the single most important
cause of attributable mortality around the world. This has driven the working
group to identify 5 specific concrete practical actions which are described in
the January 2008 issue of the Journal of Human Hypertension(1): Detect and
Prevent high BP; Assess total cardiovascular risk; Form an active partnership
with the patient; Treat hypertension to goal; Create a supportive environment.
    According to George Bakris, Director of the Department of Medicine,
Hypertensive Diseases Center, University of Chicago School of Medicine,
Chicago, USA and Steering Committee Member of the Call to Action Working
Group, "these actions, if rigorously implemented by practitioners and targeted
health-care systems throughout the world, should help to close the gap between
our therapeutic capabilities and health-care delivery and thereby save
millions of lives."
    Hypertension is a silent killer which still affects over one billion
people worldwide(2),(3). This number is expected to grow to 1.5 billion by
2025(3), causing millions of people to die prematurely or suffer irreversible
health consequences including strokes, myocardial infarction, heart failure or
kidney disease, mainly because they are not being treated to BP goal. Despite
the availability of effective treatments, 75% of the overall hypertensive
patients' population and even 50% of the patients treated are not at the
recommended goal of 140/90 mm Hg or below(4),(5),(6). Non-adherence of
patients to prescribed medication is a challenge in all chronic conditions
with only 50% of patients compliant to drugs and about 10% to lifestyle
changes in the US(7).
    "Health-care professionals should therefore be urged to keep in mind
that, even if patients feel good, it is not sufficient to merely bring them
close to the goal, instead of at goal or below", said Ernesto Schiffrin,
Physician-in-Chief and Chair, Department of Medicine, Sir Mortimer B.
Davis-Jewish General Hospital, McGill University, Montréal, Canada and member
of the Call to Action Working Group. Lifestyle changes are not only important
because of the positive impact they can have on blood pressure management, but
also for economic reasons related to the considerable cost savings that can be
obtained when patients learn how to adhere to them on a regular basis. This is
a specific area where the close relationship of nurses with patients can have
a strong influence. "Through our partnering with patients and their families,
we have found that we can develop a greater understanding for the importance
of physical exercise and better eating habits on the disease evolution
process, as well as provide tips to concerned patients on how they may
integrate better lifestyle measures into their daily lives" said Amy Coenen,
International Council of Nurses, University of Wisconsin College of Nursing,
Milwaukee, WI, USA.
    The first core action aims at detecting and treating more patients who
have dangerous levels of BP but are not being treated or are not at their
pressure goal (140/90 mm Hg or 130/80 for patients with risk factors). For
every 20/10mm Hg rise in BP above this level, the risk of death from
cardiovascular problems doubles(8). Those at greatest risk of a fatal event
include middle-aged, elderly, overweight or diabetic individuals. Their
additional cardiovascular risk factors should be thoroughly and rapidly
assessed as part of the second core action in order to prevent severe target
organ damage, such as advanced or end stage kidney disease. In the third core
action, because too many patients are not at their targeted BP goal, the group
has suggested the creation of a partnership with the patient. The objective is
to motivate patients to play a more active role in the management of their
disease and allow them to track their progress. The fourth core action
concerns the treatment goal - perhaps the most difficult but highly important
action. Physicians and health-care providers are urged to explain the
importance of adopting long-term lifestyle measures to their patients. If
insufficient, they must offer adequate, rigorous drug therapy to bring them
rapidly to the 140/90 mm Hg goal or lower in high risk patients. For patients
who are a certain way from their desired goal, recent studies confirm that
appropriate combination medications could be given right from the start.
    "In addition to proper education on diet and lifestyle measures,
prescribing therapies that patients tolerate well, can afford and take
once-a-day are ways in which physicians can improve compliance" said Trefor
Morgan, Director of the Department of Physiology, University of Melbourne,
Victoria, Australia and member of the Call to Action Working Group, on behalf
of the Asian-Pacific Society of Hypertension.
    The fifth and final step in this Call to Action seeks general support
from the patient's surrounding environment, like community organizations or
local institutions, to endorse the necessary preventive strategies and
    "There is no "one size fits all" and you cannot achieve good results
without the patient" said Giuseppe Mancia, Director of the Department of
Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy
and Steering Committee member of the Call to Action Working Group.
    Luis Miguel Ruilope, President of the Spanish Society of Hypertension and
member of the Call to Action Working Group said "By encouraging health-care
providers to think of a hand and its five fingers for each of the 5 core
actions representing the most relevant actions directed at counteracting high
BP, we could significantly impact the lives of millions of people around the
world and better prevent the painful consequences of uncontrolled

    Call to Action Working Group

    This release is endorsed by the following experts: G Bakris,
International Society of Nephrology, Department of Medicine, Hypertensive
Diseases Center, University of Chicago, Pritzker School of Medicine, Chicago,
Il, USA; M Hill, The Johns Hopkins University of School of Nursing, Baltimore,
MD, USA; G Mancia, Department of Clinical Medicine and Prevention, University
of Milano-Bicocca, Milano, Italy; K Steyn, Chronic Diseases of Lifestyle Unit,
Medical Research Council, Cape Town, South Africa; T Pickering, Behavioral
Cardiovascular Health and Hypertension Program, Columbia Presbyterian Medical
Center, New York, NY, USA; S De Geest, Institute of Nursing Science,
University of Basel, Switzerland; L Ruilope, Spanish Society of Hypertension,
Department of Medicine, Hypertension Unit, 12 de Octubre Hospital, Madrid,
Spain; T Morgan, Asia Pacific Society of Hypertension, Department of
Physiology, University of Melbourne, Victoria, Australia; S Kjeldsen,
Department of Cardiology, Ullevaal University Hospital, Oslo, Norway; EL
Schiffrin, Department of Medicine, Sir Mortimer B. Davis-Jewish General
Hospital, McGill University, Montréal, Canada; A Coenen, International Council
of Nurses, University of Wisconsin College of Nursing, Milwaukee, WI, USA;
P Mulrow, Department of Medicine, Ruppert Health Center, Medical University of
Ohio, Toledo, OH, USA; A Loh, WONCA, Department of Family Medicine, College of
Medicine Building, Singapore, Singapore; GA Mensah, World Heart
Federation,Geneva, Switzerland.
    Other members of the Call to Action Working Group include HR Black,
Department of Nephrology, New York University School of Medicine, New York,
NY, USA; TD Giles, American Society of Hypertension, Department of Medicine,
Division of Cardiology, Tulane University School of Medicine, New Orleans, LA,
    Their initiative was supported by an educational grant from Bristol
Myers-Squibb and sanofi-aventis.



    (1) Bakris G et al. Achieving blood pressure goals globally: five core
    actions for health-care professionals. A worldwide call to action.
    J Human Hypertens, 2008; 22: 63-70

    (2) Hajjar I et al. Hypertension: trends in prevalence, incidence, and
    control. Annu Rev Public Health 2006; 27: 465-90

    (3) Kearney PM et al. Global burden of hypertension: analysis of
    worldwide data. Lancet 2005; 365: 217-23

    (4) Pavlik VN, Hyman DJ. How well are we managing and monitoring high
    blood pressure? Curr Opin Nephrol Hypertens 2003; 12: 299-304

    (5) Waeber B et al. Compliance with antihypertensive therapy. Clin Exp
    Hypertens 1999; 21: 973-85

    (6) Berlowitz DR et al. Inadequate management of blood pressure in a
    hypertensive population. N Engl J Med 1998; 339: 1957-63

    (7) Haynes RB et al. Helping patients follow prescribed treatment:
    clinical applications. JAMA 2002; 288: 2880-3

    (8) Lewington S, et al. Age-specific relevance of usual blood pressure to
    vascular mortality. Lancet 2002; 360: 1903-13

For further information:

For further information: Call to Action Working Group, Agency -
Burson-Marsteller, Linda Pavy, e-mail:, Tel: +
33-1-4-1-86-76-26, Mobile: + 33-6-07-59-43-95

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