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, 72 (11), 1278-1293

Prevention and Control of Hypertension: JACC Health Promotion Series


Prevention and Control of Hypertension: JACC Health Promotion Series

Robert M Carey et al. J Am Coll Cardiol.


Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.

Keywords: antihypertensive agents; dietary sodium; exercise; lifestyle; medication adherence; telemedicine.


Central Illustration.
Central Illustration.. Prevention and Control of Hypertension.
Factors associated with hypertension awareness, treatment, and control, and the components of a systems-level algorithm designed to increase blood pressure (BP) control. Carey, R.M. et al. J Am Coll Cardiol. 2018;72(11):1278-93.
Figure 1:
Figure 1:. Schematic Depiction of the Major Determinants of BP in Primary Hypertension and Their Interactions in Adults.
Genetic/epigenetic, environmental, and social determinants interact to increase BP in virtually all hypertensive individuals and populations. BP = blood pressure. SD = social determinants.
Figure 2:
Figure 2:. Schematic Illustration of the CCM, Including Multilevel Interventions to Prevent and Control Hypertension.
Adapted with permission from Wagner (132). CCM = chronic care model; HT = hypertension.

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