Advancing the Prevention and Control of Hypertension
Lisa Terre, PhD
Lisa Terre, PhD
Abstract
Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.
Introduction
The past decade has witnessed a proliferation of evidence-based practice guidelines for the prevention and control of hypertension. Yet its prevalence has only multiplied, with no signs of leveling off any time soon.[1,2] Despite being a key driver of physician visits, medication prescriptions, and countless cardiometabolic complications, hypertension remains suboptimally controlled for many patients, with socioeconomically and culturally disenfranchised groups being disproportionately affected. Put simply, hypertension is on a worrisome public health trajectory.[19]
Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.
Introduction
The past decade has witnessed a proliferation of evidence-based practice guidelines for the prevention and control of hypertension. Yet its prevalence has only multiplied, with no signs of leveling off any time soon.[1,2] Despite being a key driver of physician visits, medication prescriptions, and countless cardiometabolic complications, hypertension remains suboptimally controlled for many patients, with socioeconomically and culturally disenfranchised groups being disproportionately affected. Put simply, hypertension is on a worrisome public health trajectory.[19]
Fortunately, the scramble for solutions has given rise to several innovative lines of inquiry. To its credit , this new crop of research has started yielding clues about some novel areas that deserve more attention. Taken together , these emerging findings have extended the focus beyond an exclusive emphasis on biological influences toward a wider-angled perspective that conceptualizes blood pressure dyscontrolas a final common pathway leading from a tangled web of biological, psychological , and social processes.[912 ] Tellingly, many of these mediators begin to exert their influences very early in the developmental process.
The Developmental Context
Accumulating evidence now indicates that the early family milieu may profoundly influence lifelong hypertension risk. For instance, early life stress has been implicated in a cascade of cardiometabolic vulnerabilities that tilt the odds toward hypertension through an intricate network of biopsychosocial mechanisms.[13 21]
To cite one of many interrelated pathways, a history of childhood adversities (including harsh parenting, family conflict or instability, and limited resources) can leave a negatively biased emotional residue that increases the likelihood of experiencing distressing emotions throughout life, which in turn heightens myriad cardiovascular risks both near and long term, including involvement in health-detrimental lifestyles (eg, physical inactivity, central adiposity, and obesity),[1012 ,22 26 ] medication nonadherence,[12] and a trail of physiological sequelae (eg, endothelial dysfunction, arterial stiffness) that further up the ante for subsequent cardiovascular events.[23,2528 ]
Of course, the actual complexity of these biopsychosocial relationships belies any simple effort at exposition. Because of the individualized nature of these transactionalnetworks, other biopsychosocial configurations also can confer risk. Illustratively, considerable evidence has suggested that prenatal and early postnatal nutrition may heighten downstream cardiometabolic hazards.[13 15 ,17 ,19 ,20 ] Likewise, maternal hypertension may compromise interuterine growth with adverse repercussions on child cognitive abilities and motor skills,[21 ] which in turn may constrain potential capacities for self-regulation .[21 ,29 ]
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The Developmental Context
Accumulating evidence now indicates that the early family milieu may profoundly influence lifelong hypertension risk. For instance, early life stress has been implicated in a cascade of cardiometabolic vulnerabilities that tilt the odds toward hypertension through an intricate network of biopsychosocial mechanisms.[13 21]
To cite one of many interrelated pathways, a history of childhood adversities (including harsh parenting, family conflict or instability, and limited resources) can leave a negatively biased emotional residue that increases the likelihood of experiencing distressing emotions throughout life, which in turn heightens myriad cardiovascular risks both near and long term, including involvement in health-detrimental lifestyles (eg, physical inactivity, central adiposity, and obesity),[1012 ,22 26 ] medication nonadherence,[12] and a trail of physiological sequelae (eg, endothelial dysfunction, arterial stiffness) that further up the ante for subsequent cardiovascular events.[23,2528 ]
Of course, the actual complexity of these biopsychosocial relationships belies any simple effort at exposition. Because of the individualized nature of these transactionalnetworks, other biopsychosocial configurations also can confer risk. Illustratively, considerable evidence has suggested that prenatal and early postnatal nutrition may heighten downstream cardiometabolic hazards.[13 15 ,17 ,19 ,20 ] Likewise, maternal hypertension may compromise interuterine growth with adverse repercussions on child cognitive abilities and motor skills,[21 ] which in turn may constrain potential capacities for self-regulation .[21 ,29 ]
DOWNLOAD COMPLETE PDF HERE
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