The NMA Announces Support Of Blood Pressure Assessments

Nurse checking patient's blood pressure(BlackDoctor.org) — The National Medical Association (NMA), The Association of Black Cardiologists (ABC) and The Association of Minority Nephrologists (AOMN) today announced their unified support and adoption of a position statement supporting noninvasive assessment of central blood pressure as a means of better diagnosis and management of hypertension.

These organizations have a long history of advocacy for minority populations, and have been at the forefront on the fight to end health disparities.

According to the Centers for Disease Control and Prevention, two out of three U.S. adults with high cholesterol and half of U.S. adults with high blood pressure are not being treated effectively. In a press release issued by the CDC earlier this year, the urgency of this issue was addressed. “Although we’re making some progress, the United States is failing to prevent the leading cause of death—cardiovascular disease—despite the existence of low cost, highly effective treatments,” said Thomas R. Frieden, MD, MPH, CDC director. “We need to do a better job improving care and supporting patients to prevent avoidable illness, disability, and death.”

Cardiovascular disease, which includes hypertensive disease, is a major health concern for all populations but particularly minority patients. “There can be no doubt that hypertension is a serious epidemic, and this is especially true amongst African Americans. The rates of high blood pressure, heart disease, stroke, kidney disease and even memory deficits can all be attributed in some way to high blood pressure.

Unfortunately the problem is with diagnosis but also effective control and treatment. The use of central blood pressure monitoring will give a better view of the hypertensive patient and help our physicians make better decisions on their treatment plans,” said Cedric M. Bright, MD, an internist and president of the NMA, the nation’s oldest and largest association of African American physicians.

Central blood pressure assessment is seen as a major advance in the identification of cardiovascular risk. It also provides physicians with more comprehensive information to improve hypertension treatment and management decisions. These leading organizations believe that the measurement of central blood pressure will advance the national effort to decrease health disparities associated with hypertension.

Hypertension, commonly referred to as high blood pressure, is rampant in African Americans when compared to other populations. Hypertension in African Americans is estimated to be 50% greater than in Caucasians, but the disparity extends beyond the simple elevation of blood pressure. African Americans experience an earlier onset of hypertension, inadequate blood pressure control, increased damage to the kidneys and other vital organs, and increased comorbidities than hypertensive Caucasians. Such disparities contribute to the soaring rates of kidney disease, stroke and heart failure among African Americans. Most patients are familiar with the traditional method of measurement of blood pressure with a simple cuff around the arm.  However, the cuff measures only the blood pressure in the upper arm. The assessment of central blood pressure is more accurate and effective because it measures the pressure at the heart.

The two measurements can be very different and central blood pressure readings have been demonstrated in clinical settings to be a better indicator of the damage high pressure can cause on the heart and other organs. Further, there is a case to be made in better therapeutic management (i.e. drug therapy), as medical professionals know that certain medications have  different effects on the pressure in the arm and the heart, so central blood pressure is a better indicator of the effectiveness of drugs to reduce high blood pressure.

“We must make headway against hypertension both in diagnosis and treatment in minority populations, particularly African Americans,” said Randall Maxey, MD PhD, a physician specializing in hypertension and renal disease. “The disparity in prevalence and inadequate treatment is unacceptable and unsustainable and we are committed to addressing this health crisis. The addition of the measurement of central blood pressure in a noninvasive manner provides invaluable clinical data necessary for improved diagnosis and management.”

Given the significant public health implications, the following policy positions were adopted by these national physician organizations:

• Central blood pressure measurement is a valuable, non-invasive clinical tool in the treatment of hypertension, especially in African Americans. Central blood pressure gives valuable information to the physician and thus may lead to improved therapeutic decisions and ultimately better control of blood pressure.

• Central blood pressure should be added to the measurements utilized by physicians and other clinicians diagnosing and treating African Americans for hypertension.

The organizations encourage that central blood pressure measurement be implemented into the standard of care for the treatment of hypertension based on the physician’s decision making. Further, there should be no impediment to the physician utilizing this tool including but not limited to access, reimbursement and eligibility requirements.

“The use of central blood pressure monitoring is a great step in the advancement of effective treatment of hypertension in all Americans, but particularly those populations like African Americans, with increased rates and inadequate treatment. Our position is that we must not lose focus on the need for effective, efficient and continued progress in the treatment of hypertension with the ultimate goal of improved patient outcomes,” said Cedric M. Bright, MD. “We are very proud to have worked together with other organizations to develop this important position statement. There are many factors that contribute to health care disparities, from environmental factors to diet to lifestyle, but the ability to better manage blood pressure via central BP assessment represents an opportunity to have impact on high blood pressure.”

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