Article Abstract:
The Centers for Disease Control claim that 58 million people in the United States have high blood pressure (HBP), increasing their risk of stroke, heart disease, and kidney failure. Nine of the 1990 Health Objectives for the Nation targeted HBP, and seven have been met, at least in part. First, at least 50 percent of adults are able to state the major risk factors for heart disease. Second, at least 90 percent of adults are able to say whether their blood pressure is high, normal, or low. Third, there are effective public programs to identify and follow-up on those with HBP in all geopolitical areas of this country. Fourth, at least 50 percent of processed foods in grocery stores list salt and calorie content. Fifth, categories for HBP control have been defined (i.e., unaware; aware, not under treatment; aware, under care, not controlled; aware, under care, controlled; aware, monitored without therapy). Sixth, regional data sets are being developed to determine the incidence of HBP, coronary heart disease, congestive heart failure, and strokes. However, the second part of this goal, ongoing surveillance of heart disease, has not been met. Seventh, control of HBP for at least 60 percent of those affected has probably been met at the older standard (160/95 mm Hg prior to 1984), but not at the newer standard of 140/90 mm Hg. There has been progress, but because nonpharmacological measures are not included, the actual success has probably been underestimated. Eighth, the goal of reducing overweight (above 120 percent of ''desired'' weight) in the population to 10 percent of men and 17 percent of women will not been met. Ninth, it cannot be determined whether average daily salt intake for adults has been reduced, because of the difficulty of measurement. The National High Blood Pressure Education Program (NHBPEP) is responsible for improvements in blood pressure control that have helped to decrease the incidence of stroke and heart disease; however, efforts and resources are needed to treat the 30 million people not in treatment, especially blacks, who are disproportionately affected by this condition. Nonpharmacologic strategies must be emphasized as well. The successful education program for HBP could be applied to other risk factors and diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Hypertension, a major risk factor for cardiovascular disease and stroke, is usually controllable by medication. The prevalence of hypertension has been very high among blacks, but seems to be declining. However, hypertension-related mortality is still a problem among younger black people. Poor compliance (failure to take medication as prescribed) is thought to be the major reason for poor hypertension control in black and white patients. To improve treatment, the factors influencing compliance were studied in a group of 54 hypertensive black women, aged 45 to 70, who were treated at a public clinic in New Orleans. One group of 22 women believed that hypertension is a biomedical disease; only 6 of these women (27 percent) complied poorly with treatment. The 32 women in the second group believed that high blood pressure is two diseases, specifically ''high blood'' and ''high-pertension''. High blood was considered to be a condition involving hot or thick blood that was controllable by diet or folk remedies. On the other hand, high-pertension was regarded as a nerve disease related to emotional excitement. Twenty of the women in the second group (63 percent) complied poorly with prescribed treatment. These results demonstrate that physicians must be familiar with patients' knowledge and beliefs in order to improve patient education and treat hypertension effectively. To meet the public health goal of decreasing hypertension and related diseases, this study indicates that it is important to spend time with each patient. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Carotid endarterectomy may be an effective method for preventing strokes in patients with severe carotid artery disease, or narrowing of the opening of the carotid artery. The procedure involves the removal of the diseased lining and fatty deposits from the interior of the carotid artery. Three research studies found that carotid endarterectomy may be more effective than non-surgical treatments for preventing strokes in patients with carotid artery disease. Post-operative complications and complications associated with pre-operative arteriography, or imaging of the carotid artery, may not outweigh the benefits of carotid endarterectomy. Ultrasound and other non-invasive imaging techniques may be safer than arteriography, but they may not be as effective. Carotid endarterectomy may be recommended for patients on the basis of the severity of the narrowing of the carotid artery and factors increasing the risk of complications.
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