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J Am Coll Cardiol. 2018 Sep 11;72(11):1278-1293. doi: 10.1016/j.jacc.2018.07.008.

Prevention and Control of Hypertension: JACC Health Promotion Series.

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Department of Medicine, University of Virginia, Charlottesville, Virginia. Electronic address:
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
Departments of Population Health Sciences, Medicine, Psychiatry and Behavioral Sciences and School of Nursing, Duke University, Durham, North Carolina. Electronic address:
Department of Epidemiology, Tulane University, New Orleans, Louisiana.


Hypertension, the leading risk factor for cardiovascular disease, originates from combined genetic, environmental, and social determinants. Environmental factors include overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium, insufficient physical activity, and consumption of alcohol. Prevention and control of hypertension can be achieved through targeted and/or population-based strategies. For control of hypertension, the targeted strategy involves interventions to increase awareness, treatment, and control in individuals. Corresponding population-based strategies involve interventions designed to achieve a small reduction in blood pressure (BP) in the entire population. Having a usual source of care, optimizing adherence, and minimizing therapeutic inertia are associated with higher rates of BP control. The Chronic Care Model, a collaborative partnership among the patient, provider, and health system, incorporates a multilevel approach for control of hypertension. Optimizing the prevention, recognition, and care of hypertension requires a paradigm shift to team-based care and the use of strategies known to control BP.


antihypertensive agents; dietary sodium; exercise; lifestyle; medication adherence; telemedicine

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