September 24, 2008 – More than three quarters of a million New Yorkers are at increased risk of heart attack or stroke due to dangerously high blood pressure, a new Health Department study shows. Of the nearly 1.5 million adult New Yorkers with high blood pressure, more than half (53%) do not have the condition under control. And because high blood pressure often progresses silently, a catastrophic event could be the first symptom many of them experience. High blood pressure is a leading of cause heart disease and stroke, which together take the lives of more than 24,000 New Yorkers every year.
The new findings, published today in the journal Circulation: Cardiovascular Quality and Outcomes, come from the City’s 2004 groundbreaking Health and Nutrition Examination Survey. The survey used interviews, physical exams and laboratory tests to assess a variety of health conditions ranging from depression to diabetes. Blood pressure readings from nearly 2,000 New Yorkers were used to measure the prevalence of hypertension in New York City, and to determine whether affected residents were getting the diagnosis and treatment needed to manage the condition.
A common condition
Overall, the survey finds that one in four adult New Yorkers (26%) has high blood pressure, compared to 30% nationally. The local rate rises to 71% among New Yorkers over 65. The study shows similar rates among men and women, but sharp disparities emerge among racial and ethnic groups, just as they have nationally. Some 33% of black New Yorkers suffer from high blood pressure, compared to 21% of whites. Accordingly, black New Yorkers are more likely than white New Yorkers to die of heart disease and stroke. If this disparity were eliminated, 800 fewer black New Yorkers would die each year. High blood pressure was also common among Hispanics, with 26% affected.
“High blood pressure remains a silent killer and we are failing to stop it,” said Dr. Thomas R. Frieden, New York City Health Commissioner. “It’s largely preventable by cutting salt in the diet, increasing physical activity, and improving nutrition – and it’s controllable with safe, inexpensive medicines. Unfortunately, fewer than half of the New Yorkers with hypertension have it under control. High blood pressure is a driving force behind heart attack and stroke. Controlling it better would save many lives, and reduce health disparities between black and white New Yorkers.”
An inadequate response
The new findings suggest that New York City’s health care system is failing to diagnose and control high blood pressure. Nearly all adult New Yorkers (99%) say they’ve had their blood pressure checked, yet 17% of those with hypertension were not aware they had it. Ten percent (10%) of those with hypertension were aware of it but were not receiving treatment. People lacking health insurance or a regular healthcare provider were less likely to be diagnosed and effectively treated, but many New Yorkers were untreated despite having access to care. And 83% of people with uncontrolled hypertension reported that they had health insurance. Studies suggest that health care providers often lack the tools needed to monitor and manage hypertension and other chronic conditions. The Health Department is working to create and promote electronic health records that can improve patients’ health.
What causes high blood pressure?
Hypertension is closely linked to high levels of salt in the diet. Salt consumption has increased since the 1970s. Americans now consume nearly twice the recommended amount of salt each day, mainly because prepared foods are so laden with it. More than three quarters of the salt consumed comes from restaurant and processed foods, and less than 10% comes from the salt shaker, which makes it difficult for people to cut back by choice.
Other countries have successfully lowered levels of salt in packaged and processed food by working with industry. In Finland and the United Kingdom, for example, voluntary reforms by the food industry have brought significant reductions in salt consumption. Many products sold in this country carry higher salt levels than those sold abroad.
Take control: How to prevent and manage high blood pressure
Blood pressure is the force of your blood pushing on the walls of your arteries. If it stays too high for too long, it can precipitate strokes, heart attacks, kidney failure and death. A blood-pressure reading includes two numbers (systolic and diastolic), one over the other. A normal reading is less than 120/80. Two or more readings higher than 140/90 qualifies as hypertension.
Simple lifestyle changes can reduce blood pressure.
- Limit salt (sodium) in your diet.
- Get at least 30 minutes of moderate exercise (such as
a brisk walk) at least five times a week.
- If you smoke, quit now. Smoking more than doubles the
risk of a heart attack in people with high blood pressure.
- If you’re overweight, losing as little as 10 pounds
can lower your blood pressure.
- Eat more fruits, vegetables and whole grains. Choose
low-fat dairy products and lean meat and fish.
- Limit alcohol consumption.
“More exercise, less salt, more fruits and vegetables – these are the keys to prevention,” said Dr. Sonia Angell, Director of Cardiovascular Disease Prevention and Control and lead author of the study. “And when diet and exercise aren’t enough, medication works, but you have to take it every day, even if you feel fine.”
Knowing your numbers and checking blood pressure regularly can help bring it under control. If you don’t know your numbers, stop at a local pharmacy. Many now offer free blood pressure checks. For more information on high blood pressure, visit: www.nyc.gov/html/doh/downloads/pdf/public/dohmhnews6-04.pdf.
Health Department Efforts to Reduce High Blood Pressure
The Health Department is working with the health care system and the community to bring down high blood pressure. Some of these efforts include:
- Developing and promoting electronic health records to
help doctors provide preventive care and manage chronic conditions. So far,
more than 750 doctors have joined the Department’s Primary Care Information
Project, and more than 750,000 patients are benefiting.
- Providing blood-pressure testing devices to
pharmacies, and distributing portable ones for home use, in the city’s most
heavily affected areas.
- Training members of faith-based organizations to
provide blood pressure testing. (More than 275 people have been trained.)
- Working with the Mayor’s Food Policy Taskforce to enact standards that reduce the amount of salt in the more than 225 million meals and snacks provided by the City of New York each year.