Hypertension, or high blood pressure, is a primary health care issue across the Americas. Hypertension is a major cardiovascular risk factor that not only reduces the quality of life for individuals, but also increases the costs of medical care. According to the 2011 Update on Heart Disease and Statistics [Roger et al., Circulation 123(4):e18, 2011] 33.5% of adults in the United States are hypertensive, which equates to an approximate 76,400,000 people. This report indicates that 80% know they have high blood pressure for which 71% are taking medication. However, only 48% of those treated actually have their blood pressure controlled underlining the critical importance for further research and understanding in an attempt to improve these statistics.
Furthermore, the same report states that in 2008, 8% of Americas were diagnosed with diabetes mellitus totalling an approximate 18,300,000 adults in this country alone. Another 7.1 million were estimated to have undiagnosed diabetes while another 36.8% were prediabetic with abnormal fasting glucose levels. There is an obvious disproportion of African Americans, Mexican Americans, and Hispanic/Latino individuals with the disease compared to Caucasian Americans. For this reason, IASH has the unique position to establish dialogue and explore common approaches within their membership of faculty encompassing all of North, Central, and South America in order to gain understanding that may translate into better treatment options for minority populations.
The epidemic of obesity occurring throughout the Western world is leading to increased annual prevalence of the metabolic syndrome and is requiring that physicians take a global approach when evaluating cardiovascular risk. Recent survey studies have shown considerable gaps in knowledge and application of guideline recommendations for cardiovascular risk reduction. The recognition and appropriate management of low and high risk patients is critical especially by primary care physicians. A recent study by Doroodchi et al. (BMC Family Practice 2008, 9:42-50) demonstrated that the cost of medications (88%), adherence to medications (74%), adequate time for counseling (56%), patient education tools (47%), knowledge and skills to recommend dietary changes (48%), and patient adherence (52%) were cited as significant barriers to cardiovascular disease risk management. A study (Holland et al, Disease Management 2008, 11:71-77) showed contradictory results in regards to providers’ knowledge of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) hypertension management standards and how they routinely apply this knowledge in their clinical practices. 94% of physicians cited familiarity with JNC-7 guidelines yet none of the physicians reported completion of hypertension care management plans for their patients. Data summarizing the extent to which physicians follow lipid treatment guidelines and the degree to which their patients reach treatment target levels indicates a significant gap between guidelines and practice. One study found that although 96% of subjects qualified for lipid therapy, only 47% received any treatment (Schrott et al, JAMA 1997, 277:1281-1286).
These recent surveys indicate a startling disconnect between the awareness of appropriate clinical management and actual treatment. And yet the field of cardiovascular disease, and in particular the area of hypertension, is undergoing a scientific renaissance in part because of the explosion of new knowledge from the Human Genome project which has led to recent advances in new methods for studying mechanisms as well as developments in genomic science and molecular medicine. Therefore, it is imperative that there is a medium to connect the advances in scientific knowledge with understanding in how to improve the management of hypertension and associated disorders in clinical practice. For this reason, the primary mission of IASH is the understanding, prevention, and control of hypertension and vascular diseases with emphasis on bridging basic, translational and clinical research across the Americas.