Johns Hopkins School of Nursing, Baltimore, Maryland, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Am J Hypertens. 2022 Mar 8;35(3):232-243. doi: 10.1093/ajh/hpab182.
Hypertension treatment and control prevent more cardiovascular events than management of other modifiable risk factors. Although the age-adjusted proportion of US adults with controlled blood pressure (BP) defined as <140/90 mm Hg, improved from 31.8% in 1999-2000 to 48.5% in 2007-2008, it remained stable through 2013-2014 and declined to 43.7% in 2017-2018. To address the rapid decline in hypertension control, the National Heart, Lung, and Blood Institute and the Division for Heart Disease and Stroke Prevention of the Centers for Disease Control and Prevention convened a virtual workshop with multidisciplinary national experts. Also, the group sought to identify opportunities to reverse the adverse trend and further improve hypertension control. The workshop immediately preceded the Surgeon General's Call to Action to Control Hypertension, which recognized a stagnation in progress with hypertension control. The presentations and discussions included potential reasons for the decline and challenges in hypertension control, possible "big ideas," and multisector approaches that could reverse the current trend while addressing knowledge gaps and research priorities. The broad set of "big ideas" was comprised of various activities that may improve hypertension control, including: interventions to engage patients, promotion of self-measured BP monitoring with clinical support, supporting team-based care, implementing telehealth, enhancing community-clinical linkages, advancing precision population health, developing tailored public health messaging, simplifying hypertension treatment, using process and outcomes quality metrics to foster accountability and efficiency, improving access to high-quality health care, addressing social determinants of health, supporting cardiovascular public health and research, and lowering financial barriers to hypertension control.
高血压治疗和控制可预防更多心血管事件，优于其他可改变的风险因素管理。尽管美国成年人的年龄调整后血压控制比例（定义为<140/90mmHg）从 1999-2000 年的 31.8%改善至 2007-2008 年的 48.5%，但在 2013-2014 年保持稳定，并在 2017-2018 年下降至 43.7%。为了解决高血压控制的迅速下降，国家心肺血液研究所和疾病控制与预防中心心脏病和中风预防司召集了一个多学科国家专家虚拟研讨会。此外，该小组还试图确定扭转这一不利趋势并进一步改善高血压控制的机会。该研讨会恰逢卫生与公众服务部部长发布《控制高血压行动呼吁》，该呼吁承认高血压控制进展停滞不前。演讲和讨论包括下降的潜在原因和高血压控制的挑战、可能的“大创意”，以及多部门方法，这些方法可以扭转当前趋势，同时解决知识差距和研究重点。广泛的“大创意”包括各种可能改善高血压控制的活动，包括：让患者参与的干预措施、促进有临床支持的自我测量血压监测、支持团队护理、实施远程医疗、加强社区临床联系、推进精准人群健康、制定定制的公共卫生信息、简化高血压治疗、使用过程和结果质量指标促进问责制和效率、改善获得高质量医疗保健的机会、解决健康的社会决定因素、支持心血管公共卫生和研究、降低高血压控制的财务障碍。
