What You Don’t Know Could Hurt You
Many health care providers have seen this scenario happen repeatedly: a patient is found to have elevated blood pressure readings on a routine visit to the physician’s office. Further questioning demonstrates that the patient doesn’t remember the last time they had their blood pressure checked. When the patient is asked if they know they have high blood pressure, they respond: “I had no idea!”
High blood pressure remains one of the leading risk factors for cardiovascular disease and affects almost half of the U.S. population. Cardiovascular disease is the leading cause of mortality for both men and women, claiming more lives annually than all solid organ cancers combined. Of the people who have high blood pressure, the majority do not have adequate medical control. Uncontrolled hypertension is an independent risk factor for heart attack, heart failure, stroke, kidney failure and a host of other health care issues.1 And yet despite the fact that hypertension remains one of the leading risk factors for heart disease, public awareness of the risks of hypertension remains limited.
An online survey by the American Heart Association and the American Medical Association highlights the need for continued work around raising awareness of this silent killer. Of the 1001 adults surveyed, just over a third carried a diagnosis of hypertension. Approximately 40% of those surveyed indicated not knowing what their blood pressure is. Of the people with known hypertension, only 38% reported having their blood pressure measured in the prior week. Sadly, almost two thirds of respondents that had been diagnosed with high blood pressure had a low level of worry about their condition. Only 10% of all adults surveyed listed blood pressure management as their top health priority. This number only increased to 22% for those with a known diagnosis of hypertension.4
Raising Awareness Through Education
May is National High Blood Pressure Education month, with the goal of raising awareness of the risks of high blood pressure, and the importance of treating it. Of the over 116 million American adults with high blood pressure, 79% do not have adequate control.3 Many patients walk around for years with high blood pressure before being diagnosed and treated.
If you asked almost anyone walking down the street about the risk of cigarettes, most would respond “lung cancer”. People have a strongly imprinted association between the causative risk of smoking to lung cancer. Many of those who choose to smoke are aware of the increased risks they expose themselves to. This is the result of extensive efforts towards public education, dating back to the landmark surgeon general’s report in 1964 detailing the results and findings of an elected national taskforce committee on smoking. The release of the report by then Surgeon General Luther L. Terry impacted public perception and shaped policy for years thereafter.
What if you asked the same group of people walking down the street about the risks of high blood pressure? Most people know that hypertension is deleterious, but do they know why? Do they know they are at increased risk of stroke, heart failure, heart attack, kidney failure, or vision loss? The associations of hypertension to these severe diseases are not as strong in the public perception. Hypertension is a preventable risk factor for heart disease and stroke. But awareness needs to be raised of the downstream risks of untreated hypertension, with the hopes of improving diagnosis, surveillance and treatment. Raising awareness through public education is one of the most important tools we have in reducing the burden of chronic disease.
In October 2020, Surgeon General VADM Jerome M. Adams, M.D., M.P.H., issued a Call to Action urging Americans to recognize and address hypertension control as a national, public health priority. The Call to Action to Control Hypertension provides strategies for those on the frontlines of health care and public health to address this costly, dangerous and far too common chronic health condition. The focus on prioritizing heart health has grown amid this Call to Action and the CDC’s recommendation that employers should now provide coverage for automated home blood pressure monitors.
You Can’t Control What You Don’t Measure
Knowing truly is half the battle in improving awareness around the dangers of high blood pressure and altering a persons’ health trajectory. The good news is that high blood pressure, the silent killer, is hiding in plain sight. Blood pressure is easy to check, does not require an invasive test or blood draw to measure, and can be evaluated on a regular basis from home.
The American Heart Association has released guidelines recommending home self-measurement of blood pressure as an important tool in evaluating the effectiveness of treatment in people diagnosed with high blood pressure. Several clinical studies have demonstrated improved diagnosis and treatment of high blood pressure with self-measured blood pressure at home. Sporadic visits to the doctor don’t often give an accurate picture of what is going on in a person's day to day life and may result in “white coat” hypertension, a transient rise in blood pressure when it is measured in the doctor’s office. Increasing the data points of care through home measurement may provide a much more accurate and reliable picture of a person’s true blood pressure over time, allowing for more effective monitoring of treatment strategies.
Hello Heart is helping in the fight against high blood pressure through a digital coaching app that empowers people in their own healthcare. People can easily incorporate the app into their everyday lives, outside of the occasional trips to the doctor’s office or hospital. In a recent study looking at over 28,000 people using Hello Heart, significant reductions were seen in systolic blood pressure in stage 2 hypertensive participants (baseline blood pressure over 140/90) which was sustained over three years. When it comes to blood pressure, knowledge about your numbers truly is power. Hello Heart is giving people that power, and giving users control over their own health.
What Can You Do Now?
Not all patients who have high blood pressure need medications. There are some simple measures that can improve your heart health and may reduce your risk of having a serious medical event like a heart attack or stroke. These include regular exercise, eating a healthy diet, and limiting salt intake. For many people, high blood pressure medications are needed, and it is best to consult with your physician to determine the optimal treatment plan. Unfortunately, many people who meet criteria for medication remain untreated.3 It all starts with raising awareness and knowing your numbers.
1: Facts About Hypertension. CDC Web site. https://www.cdc.gov/bloodpressure/facts.htm. Published September 27, 2021. Accessed May 27, 2022.
2: Ahmed FB, Anderson RN. The Leading Causes of Death in the US for 2020. JAMA. 2021;325(18):1829-1830. https://jamanetwork.com/journals/jama/fullarticle/2778234. Accessed May 27, 2022.
3: Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. Million Hearts Web site. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Published March 22, 2021. Accessed May 27, 2022.
4: What patients don't know about BP, stroke: You might be surprised. https://www.ama-assn.org/print/pdf/node/33916. Published June 2019. Accessed May 27, 2022.
5: The 1964 Report on Smoking and Health. https://profiles.nlm.nih.gov/spotlight/nn/feature/smoking. Published 1964. Accessed May 27, 2022.
6: Monitoring Your Blood Pressure at Home. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home. Published November 2017. Accessed May 27, 2022.
7: What you need to know about self-measured blood pressure monitoring. https://www.ama-assn.org/delivering-care/hypertension/what-you-need-know-about-self-measured-blood-pressure-monitoring#:~:text=Randomized%2Dcontrolled%20trials%20have%20shown,office%20blood%20pressure%20readings%20alone. Published January 2019. Accessed May 27, 2022.
8: Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed May 27, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. There were 108 participants with baseline blood pressure over 140/90 who reduced their blood pressure, had been enrolled in the program for 3 years, and had application activity during weeks 148-163. See additional important study limitations in the publication.)
Hello Heart does not provide medical advice. You should always consult with your doctor about your individual care.
1. Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed October 19, 2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https:/www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed October 19, 2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.
2. Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021- Final.pdf. Published October 2021. Accessed October 19, 2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-fundedemployer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)