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High blood pressure is the leading risk factor for heart disease, the prevalence of hypertension globally is high and continues to increase. High blood pressure is associated with an increased risk of stroke, ischemic heart disease, heart failure and noncardiac vascular disease and other conditions. Hypertension is caused by a combination of genetic, environmental and social determinants.
Genetic predisposition is nonmodifiable and conveys lifelong cardiovascular risk, the risk for hypertension is modifiable and largely preventable due to a strong influence by key environmental and lifestyle factors. Modifiable lifestyle factors, which are gradually introduced in childhood and early adult life, include being overweight, unhealthy diet, high sodium and low potassium intake, sedentary lifestyle and consumption of alcohol.
Race and socioeconomic status are also risk factors for hypertension. High blood pressure is more prevalent in black and Hispanic populations. Prevention and control of hypertension can be achieved through targeted and population-based strategies. The targeted approach is the traditional strategy used in health care practice and seeks to achieve a clinically important reduction in blood pressure for individual patients.
The population-based strategy aims to achieve small reductions that are applied to the entire population, resulting in a small downward shift in the entire blood pressure distribution. Studies have shown that the population-based approach may be better at preventing cardiovascular disease compared with the targeted strategy. Factors preventing successful hypertension control include inaccurate blood pressure measurement and diagnosis of hypertension, lack of hypertension awareness and access to health care, proper hypertension treatment and control and low rates of medication adherence.
The model includes six domains: decision support, self-management support, delivery design, information systems, community resources and health care systems which have been shown to lead to activated patients, responsive health care teams, improved health services and treatment outcomes, and cost-effectiveness. It also recognizes a collaborative partnership between the patient, provider and the care team.