Behavior changes and the prevention of high blood pressure. Workshop II. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health.

H igh blood pressure is among the most common and most important of the risk factors for cardiovascular and renal diseases.1 Recent estimates based on the 1988-1991 National Health and Nutrition Examination Survey indicate that approximately 50 000 000 people in the United States have high blood pressure. Despite the clear benefits of treating established hypertension, this approach alone will not prevent all blood pressure-related disease in the population because blood pressure-related vascular complications can occur before the onset of established hypertension. The blood pressure-cardiovascular disease risk relation is continuous and progressive, even within the normotensive blood pressure range. Furthermore , it is difficult to ensure that all hypertensive patients are identified and treated adequately.23 Even those who derive optimal benefit from antihypertensive treatment are likely to have a higher risk of morbidity and mortality than their untreated normotensive counterparts with a similar blood pressure.4 Moreover, once treatment with pharmacological therapy is initiated, there will inevitably be some adverse effects. For these reasons, hypertension treatment is an important but incomplete response to the population burden of blood pressure-related cardiovascular disease. Primary prevention of hypertension is a natural extension of hypertension treatment and provides an important opportunity to interrupt and prevent the costly cycle of managing hypertension and its complications. Therefore, we encourage a focus on primary prevention for normotensive people as well as for those with high-normal blood pressure or hypertension. Primary prevention of hypertension can be accomplished through interventions on a general-population level (population strategy) with the objective of shifting the distribution of blood pressure downward. This approach should be complemented by efforts to lower blood pressure among the higher-risk populations (targeted strategy), which include African-Americans, people with high-normal blood pressure, those with a family history of hypertension, and people with one or more lifestyle factors that contribute to age-related increases in blood pressure. The lifestyle factors that are directly related to the development of hypertension include excessive consumption of calories, leading to obesity; high sodium chloride intake; excessive alcohol consumption ; and physical inactivity. Moreover, interventions in these behaviors have shown promise for preventing high blood pressure.5 Therefore, a behavioral approach, as discussed below, is the basis for policy and intervention strategies to prevent hypertension. It is important to integrate this strategy with emphasis on other behavioral patterns that interact with high blood pressure to increase cardiovascular risk, such as smoking or dietary practices that increase dyslipidemia. Evidence …