Arresting the silent killer: high blood pressure
January 31, 2013

The new year is traditionally a time for resolutions and fresh starts. As we pledge to eat better, exercise more and lose those extra pounds, itaEUR(TM)s worth considering how much healthier aEUR" and wealthier aEUR" our nation would be if we all stuck to our resolve.

If we had to choose a single public health goal that would have the most impact at the lowest cost, it would be controlling high blood pressure, according to Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, at our Partnering for Cures meeting in November.


According to the CDC, high blood pressure was a primary or contributing cause of death for more than 348,000 Americans in 2009, or about 950 deaths each day. ItaEUR(TM)s a silent killer with no warning signs or symptoms, and as many as one in five adults is unaware they have it.

Blood pressure is the force of blood against the walls of the arteries, which carry blood from the heart to other parts of the body. Blood pressure is not constant: It may rise and fall throughout the day. But if it remains elevated for extended periods of time (also known as hypertension), it can damage the heart and increase the risk of heart disease and stroke, which are leading causes of death in the United States (see map).

Healthy blood pressure is 120/80 mmHG (millimeters of mercury); levels greater than 140/90 are considered unhealthy; and levels between the two are considered to be prehypertension. The CDC estimates that one in three American adults aEUR" 67 million aEUR" already has hypertension and that one in three is on their way if their condition remains unchecked. Even more alarming, 53 percent of those with hypertension donaEUR(TM)t have it under control.

What about costs? Health economists typically compare the costs of taking action (in this case, treating hypertension or changing our lifestyle) with the costs of doing nothing. The Milken InstituteaEUR(TM)s 2007 study aEURoeAn Unhealthy AmericaaEUR? estimated that by 2023 the United States could avoid $23 billion in direct treatment costs and $172 billion in lost worker productivity if we acted to reduce hypertension.

How do we get high blood pressure in the first place? Certain medical conditions aEUR" most commonly diabetes and prehypertension aEUR" can increase the chances of developing high blood pressure. Other culprits are unhealthy behaviors including but not limited to smoking tobacco, eating foods high in sodium and low in potassium, being obese, drinking too much alcohol and not exercising enough.

So what can we do to arrest this silent killer? The CDC advises us to know our numbers, get treatment and change our lifestyle. But the greatest impact on reducing high blood pressure might come from an unexpected source: the workplace. The Million Heartsa,,? Program by the Department of Health and Human Services provides actionable steps for employers that include providing health insurance coverage with no or low out-of-pocket costs for blood pressure medications or home monitoring devices; providing one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure and prehypertension; and offering various incentives to stop smoking, eat better and exercise.

This year, letaEUR(TM)s stick to our resolve and improve the nationaEUR(TM)s well-being. Now, that would be something to celebrate.