“Primordial prevention”

“It seems to me that hypertension is now a pediatric disease,” says current ASH president Henry Black, MD, director of hypertension research at New York University School of Medicine in New York City. “It’s something we have to prevent before the blood vessels have the problems we see in adulthood if we’re going to do anything about this so-called cardiovascular epidemic. We have to act now.”

He urges all clinicians to take a “primordial” approach to wellness. “Primary prevention is for patients who have a risk factor but haven’t yet had an event. Secondary prevention is for people who have had an event, and we don’t want them to have another one,” Dr. Black explains.

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“What we really need to talk about is preventing risk factors from developing in the first place, which some of us call ‘primordial prevention.’ This is where we ought to be focusing.”

Despite their sense of urgency, these ASH experts concede there is only so much a clinician can do.

Primary-care providers have been more successful in preventing obesity than in treating it, says Dr. Falkner. “They’ve been working with families to attend to diet and increase physical activity, but to reverse obesity is very difficult; obese children are often part of obese families.”

“Ultimately, this is all about patient responsibility,” notes Dr. Bakris. “The clinician’s role here is to educate and empower the patient. It’s the patient’s responsibility to take control.”

But patients and providers alike are going to need help. “Unless there is some kind of governmental intervention that puts physical education back in the schools and changes the diet kids are getting, [our efforts] won’t work,” he asserts.

Ms. Dembrow is senior editor for The Clinical Advisor.

1. Bakris GL, Sowers JR; American Society of Hypertension Writing Group. ASH position paper: treatment of hypertension in patients with diabetes—an update. J Clin Hypertens. 2008;10:707-713.
2. Holman RR, Paul SK, Bethel MA, et al. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med. 2008;359:1565-1576.
3. Cutler JA, Sorlie PD, Wolz M, et al. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008;52:818-827.
4. Centers for Disease Control and Prevention (CDC). State-specific incidence of diabetes among adults—participating states, 1995-1997 and 2005-2007. MMWR Morb Mortal Wkly Rep. 2008;57:1169-1173.
5. Falkner B. Children and adolescents with obesity-associated high blood pressure. J Am Soc Hypertens. 2008;2:267-274.

All electronic documents accessed January 8, 2009.