to be Reckoned With

The threat

● High blood pressure affects 65 million Americans.

● Another 59 million Americans have prehypertension, which increases their

chances of developing cardiovascular disease.

● People over 55 have a 90 percent chance of developing high blood pressure

in their lifetime.

● High blood pressure can lead to other life-threatening illnesses.

● These include the #1, #3, and #9 causes of death in the United States: heart

disease, stroke, and kidney disease.

● As the United States population becomes older—and increasingly overweight

and obese—high blood pressure will become an even bigger problem.

Unless we act now.

The solution

● High blood pressure can be prevented and controlled.

● We must work together to accomplish this. 

● We have more knowledge about prevention and better treatment 

options than ever before. 

● We must use this new information to save ourselves and 

future generations.

Together, we can prevent and control 

a health problem that affects 1 in 3 

American adults: high blood pressure

1

death in the United States for both men and women. ●
The Mission: Save Millions of Americans

2

● High blood pressure is a factor in 69 percent of heart attacks in the United States

Prehypertension (120/80 to 139/89 mmHg) increases

heart disease* and stroke risk in both men and women 

45 percent

increased risk

100 percent

increased risk

men women

*Including heart attack and coronary heart disease

High blood pressure: 

A force to be reckoned with

Blood pressure is the force of blood against the walls of arteries. When

that force stays too high, it becomes a life-threatening condition—high

blood pressure (also called hypertension). It makes the heart work too

hard, hardens the walls of arteries, and can cause the brain to 

hemorrhage or the kidneys to function poorly or not at all. The toll 

on American lives, quality of life, and health care costs is staggering.

Risky business

Anyone can develop high blood pressure. But these factors increase the

odds: being overweight or obese, being physically inactive, high salt and

sodium intake, low potassium intake (due to not eating enough fruits

and vegetables), excessive alcohol consumption, and diabetes.
less than

120/80 mmHg

Optimal blood pressure

the pressure of blood 

in the vessels when 

the heart beats: 

systolic pressure

the pressure between 

beats when the 

heart relaxes: 

diastolic pressure

millimeters of mercury

High

blood pressure

140/90 mmHg

or higher

Prehypertension

between 120-139

and/or 80-89 mmHg

Optimal

blood pressure

less than

120/80 mmHg

How many lives can we improve?

● The 65 million Americans who already have high blood pressure.

● The 59 million Americans who have prehypertension, which tends to

progress to high blood pressure.

● The 18 million people with diabetes who are more likely to develop

high blood pressure than the population at large. 

● The 122 million American adults who are overweight or obese and,

therefore, more likely to develop high blood pressure than the population at large. 

● The nearly 60 million Americans ages 55 and over whose chances of

developing high blood pressure during their lifetimes are 90 percent.

Everyone needs to know their numbers

● There are often no signs or symptoms.

● That’s why high blood pressure is called the silent killer.

● Blood pressure numbers are the only warning.

3

● High blood pressure is a factor in 77 percent of strokes—the #3 cause of death in the United States. ●
Strategies for Saving Lives

4

● Young African American adults are twice as likely as Caucasians to have high 

➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤➤

Treat hypertension

Physicians and patients can now control high blood pressure more 

effectively than ever before. Simple, and often modest, lifestyle changes 

can quickly improve health and quality of life, and there are a variety of

effective medicines available to control high blood pressure.

Take special measures within the African

American community

High blood pressure is a major factor underlying African Americans’ lower

life expectancy. It is also the most important reason why African Americans

are 4 times more likely to develop kidney failure than Caucasians. 

African American women are especially affected. They are 3 times more

likely to die of heart disease or stroke before age 60 than Caucasian women.

Protect older Americans

The likelihood of developing high blood pressure increases with age. New

research shows that middle-aged and older Americans have a 90 percent

chance of developing high blood pressure in their lifetimes. Treating high

blood pressure in older people can reduce their odds of having a heart attack

by 27 percent, a stroke by 35 percent, and heart failure by 54 percent.

Protect women

More women than men have died of cardiovascular diseases every year

since 1984. As many women die from these diseases each year as the next

6 causes of death combined, including breast cancer. Early detection and

treatment of high blood pressure could prevent many of these deaths.

Establish healthy habits

Keys to prevention: losing weight, if overweight, and maintaining a healthy

weight; being physically active; following an eating plan that emphasizes

fruits and vegetables and lowfat dairy foods, is moderate in total fat, and

low in saturated fat and cholesterol; eating less salt and sodium; controlling

blood sugar if you are diabetic, and if you drink alcoholic beverages, doing

so in moderation.
Lose weight if overweight, and maintain a 

healthy weight.

Follow an eating plan that emphasizes fruits, vegetables,

and lowfat dairy foods, and is moderate in total fat and

low in saturated fat and cholesterol.

If you drink alcoholic beverages, do so 

in moderation.

Be physically active.

Work up to at least 30 minutes of a moderate-level activity,

such as brisk walking or gardening, each day.

Reduce salt and sodium intake.

Choose and prepare foods with less salt and add less salt at

the table. Read food labels to choose canned, processed,

and convenience foods that are lower in sodium.

Ask your health care 

professional what your

blood pressure numbers

are and what they mean.

If you need medication,

make sure you understand

what it’s for and how and

when to take it, then take it as your doctor recommends.

Quit smoking.

Smoking injures blood vessel walls and speeds up the

process of hardening of the arteries. It increases the risk

of stroke, heart disease, peripheral arterial disease, and

several forms of cancer.

Control your blood sugar if you have diabetes.

Individual actions

New knowledge is already saving lives

By applying new knowledge, we can do more to prevent and control high blood

pressure. These are some recent findings that are already making a difference. 

● Systolic blood pressure, the top number in a blood pressure reading, is key to

watch—especially in older Americans. Research shows that the effective 

treatment of high systolic blood pressure saves lives and greatly reduces illness.

● Prehypertension presents more danger than earlier believed. Millions of

Americans with blood pressures between 120/80 and/or 139/89 mmHg are 

at greater risk of developing high blood pressure, heart disease, and kidney

failure. In fact, new research shows that the odds of your developing heart

disease and stroke start to increase at levels as low as 115/75 mmHg and

double for each 20/10 mmHg.

● An eating plan that emphasizes fruits, vegetables, and lowfat dairy foods, is

lower in salt, moderate in total fat, and low in saturated fat and cholesterol can

prevent and lower high blood pressure.

● Recent improvements in control rates show that more Americans than 

ever are succeeding in controlling their high blood pressure, proving that

change is possible.

5

 blood pressure. ● High blood pressure precedes 74 percent of cases of heart failure. ●

➤➤➤➤➤
Naming the Mission: Achieving the

Goals

● By the year 2010 we will accomplish our mission. 

● 50 percent of Americans will have their high blood pressure 

under control.

● 95 percent of Americans will know if their blood pressure is 

normal or high. 

● The percentage of Americans with high blood pressure will be 

reduced from 25 percent to 16 percent.

● The risk of a heart attack in older Americans will be reduced by 

27 percent.

● The risk of stroke in older Americans will be reduced by 36 percent.

● The risk of heart failure in older Americans will be reduced by 

54 percent.

● Millions of Americans will have taken steps to prevent and control 

high blood pressure.

● Many lives and billions of dollars will be saved.

6

● High blood pressure is the second leading cause of chronic kidney failure in the 

Healthy People 2010

Healthy People 2010 is a national health promotion and disease

prevention initiative to reduce illness and deaths in the United

States and improve the quality of life for all Americans.

Steps to a HealthierUS

Steps to a HealthierUS is a prevention initiative from the U.S.

Department of Health and Human Services that advances

President George W. Bush’s HealthierUS goal of helping Americans

live better, longer, and healthier lives. It focuses on reducing the

burden of chronic diseases and addressing the lifestyle choices

that are responsible for some of the leading causes of death and

disability in this country, including heart disease and stroke for

which high blood pressure is a major risk factor.
Goals of Healthy People 2010

Action plan

● Make the benefits of simple actions understood and embraced. 

● Involve every individual and institution of society in playing a role. 

● Create new, innovative partnerships—with cities, towns, civic groups,

and businesses. 

● Enlist key players in making a difference—such as encouraging food

manufacturers to reduce sodium in processed food.

● Mobilize those who share a common purpose in reducing death and 

disability from high blood pressure. 

● Promote and market tailored tools and messages for individuals 

working to achieve improved personal health. 

7

 United States—responsible for 26 percent of all cases. ●

Reduce health care costs by billions

In 1998 alone, $109 billion—12 percent

of all diagnosis-specific spending—was

spent on health care for high blood 

pressure and its complications, including

$22 billion spent directly on high blood

pressure.

● Treating high blood pressure in older people can reduce the risk

of heart attacks by 27 percent, averting 190,000 cases annually

and providing annual savings of $1.9 billion. Treatment can also

avert 180,000 strokes and 300,000 cases of heart failure annually, 

saving approximately $3.4 billion each year.

● High blood pressure causes more visits to doctors than any

other condition, accounting for 48 million visits per year. Even a

20 percent decline would provide savings of $956 million. 

We know what to do to reduce the risks and costs. 

But we need your help.
Join the Mission: Partnerships To

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● High blood pressure causes more visits to doctors than any other 

Communities

Mobilize health care groups, faith-based organizations,

and other community and civic groups. Use community

health fairs to profile the role high blood pressure plays

in overall health for individuals and communities. 

Health care professionals

Tell every patient what their blood pressure

numbers mean and educate them about 

the risks of high and high normal blood

pressure. Promote practice services by

speaking at community events about the

dangers of high blood pressure. 

Insurance and managed care

Develop innovative programs to reduce claim

costs—rewarding lower blood pressures with lower

premiums. Enclose flyers in monthly premium

statements to educate subscribers about preventing

and controlling high blood pressure.

Teachers and educators

Be a role model to prompt and reinforce the benefits of

healthy eating and regular physical activity as a way of

life. Organize health education days to bolster health

classes. Work toward eliminating unhealthy snacks in

vending machines.

The National High Blood

Pressure Education Program

is a partnership of leading

national organizations that have

enlisted in this vital mission to

create a healthier America. Don’t

wait to add your organization to

this prominent list.

National Heart, Lung, and Blood Institute ●

American Academy of Family Physicians ●

American Academy of Insurance 

Medicine ● American Academy of

Neurology ● American Academy of

Ophthalmology ● American Academy of

Physician Assistants ● American

Association of Occupational Health 

Nurses ● American College of 

Cardiology ● American College of Chest

Physicians ● American College of

Occupational and Environmental 

Medicine ● American College of

Physicians ● American Society of 

Internal Medicine ● American College of

Preventive Medicine ● American

Dental Association ● American

Diabetes Association ● American Dietetic

Association ● American

Heart Association ● American

Hospital Association ● American Medical

Association ● American

Nurses Association ● American

Optometric Association ● American

Osteopathic Association ● American

Pharmaceutical Association ● American

Podiatric Medical Association ● American

Public Health Association ● American Red

Cross ● American Society of HealthSystem Pharmacists ● American Society 

of Hypertension ● Association of Black

Cardiologists ● Citizens for Public 

Action on High Blood Pressure and

Cholesterol, Inc. ● International Society

on Hypertension in Blacks ● National

Black Nurses Association, Inc. ● National

Hypertension Association, Inc. ● National

Kidney Foundation, Inc. ● National

Medical Association ● National Optometric

Association ● National Stroke Association ●

Society of Geriatric Cardiology ● Society

for Nutrition Education ● Agency for

Healthcare Research and Quality ● Centers

for Medicare and Medicaid Services ●

Department of Veterans Affairs ● Health

Resources and Services Administration ●

National Center for Health Statistics ●

National Institute of Diabetes and Digestive

and Kidney Diseases ● NHLBI Ad Hoc

Committee on Minority Populations