In the midst of December's gloomy economic reports was positive health news from the American Heart Association: Heart and stroke death rates have dropped approximately 30% since 1999.

However, this good news is offset by the fact that the risk factors for heart disease and stroke - the nation's No. 1 and No. 3 killers, and major contributors to disability and health care costs - have not shown similar declines. What's more, two of those risk factors, high blood pressure and obesity, actually are increasing.

"If this trend continues," commented AHA President Timothy Gardner, M.D. "death rates could begin to rise again in the years ahead. While we have seen better control of high blood pressure, high cholesterol and tobacco use, we still have much work to do on these risk factors."

Focus on hypertension

The Centers for Disease Control and Prevention reports that high blood pressure, or hypertension, affects approximately 65 million Americans, many of whom are young. These individuals have a 50% greater lifetime risk of stroke than those with normal blood pressure, according to AHA.

African Americans are at even higher risk for hypertension than whites, Mexican Americans and Asian/Pacific Islander adults. High blood pressure tends to be more common, happens at an earlier age and is more severe for many African Americans, putting them at higher risk for heart attack, stroke, heart failure and kidney complications. Also, it's estimated that two-thirds of people aged 60 and older will develop hypertension.

"In 90% to 95% of high blood pressure cases, the cause is unknown. People can have high blood pressure for years without knowing it. That's why it's called the 'silent killer' - it creeps up on you," states AHA.

Fortunately, hypertension can be controlled with medication and lifestyle modification - but only when people are diagnosed and comply with treatment regimens. Of the 65 million Americans with the disease, it's estimated that only 59% are receiving treatment, and of those, only about 34% achieve adequate control of their blood pressure. One reason appears to be noncompliance; a major study showed that 43% to 78% of patients being treated for hypertension failed to adhere to recommended therapies.

Encourage generics

Why don't people take their blood pressure medication? Physicians say one reason is that hypertension has no symptoms, so patients cannot see or feel the benefits. Therefore, they have no incentive to stay on prescribed drugs.

Another reason for noncompliance is the cost of prescription drugs, and this problem could get worse. Employees are coping with rising costs in all areas of health care. Watson Wyatt reported recently that the average health plan deductible is now over $1,000, which doesn't leave much left over for medications.

While newer brand-name hypertension drugs can be pricey, there are many reasonably priced alternatives that can be included and encouraged in employers' drug plans, says Dr. Brian Solow, a practicing physician and medical director for Prescription Solutions, a leading pharmacy benefit manager.

"High cost is not an issue with hypertension drugs unless people do not have insurance," he says. "Even then, the availability of generics (bioequivalents) and generic alternatives (drugs in the same class) means that there shouldn't be barriers to getting this medication."

The majority of patients with hypertension can get by with proven medications that have been on the market for awhile, Dr. Solow says. Physicians normally turn to these first because the efficacy and safety are well-established. "We don't steer patients to new medications unless that's indicated," he notes.

Drug plans with low or no copays for generics will keep hypertension medication affordable. In addition, hypertension drugs are "a perfect example" of drugs that should be available through mail-order prescription plans, Dr. Solow says. "Hypertension is a chronic disease, and people need to be on medication for a lifetime. Mail-order plans encourage adherence to treatment regimens."

Screening and education

Of course, before a disease is treated, it must be diagnosed. Employers can attack hypertension on this front by offering blood pressure screenings backed with wellness programs and health education.

"Employers do a good job promoting and providing screenings that expose employees to blood pressure readings, which is very important because many people don't regularly visit a physician," observes Dr. Solow. "However, they often don't provide employees with the necessary resources for taking the next step."

Blood pressure should normally be less than 120/80. Someone who has a blood pressure reading above that should be told to follow up with his or her doctor to confirm whether or not she has high blood pressure, which is 140/90 or greater. Blood pressure that stays between 120-139/80-89 is considered considered "pre-hypertension," meaning it is more likely that person will develop high blood pressure.

A diagnosis of high blood pressure is based on numerous readings. Dr. Solow advises: "At workplace screenings, it's important to tell employees, 'This is just one reading, and we recommend that you follow up with a doctor. Do you know how you might contact a provider?' Then, have printed cards available so they know whom to call. Also, make people aware of any benefits you offer that can help them make necessary lifestyle changes, such as a smoking cessation program."

Lifestyle changes: Low cost, high impact

Lifestyle changes can help lower blood pressure and possibly eliminate the need for drugs. The following steps, detailed on the AHA and Revolution Health Web sites, cost little or nothing and can pay handsome dividends:

1. Maintain a healthy weight.

The AHA and the National Heart, Blood and Lung Institute recommend a diet rich in fruits and vegetables; high in low-fat dairy products, potasium, magnesium and calcium; and low in total saturated fats.

"Following this plan has been shown to produce mean reductions of 6 mm Hg in systolic blood pressure and 3 mm Hg in diastolic blood pressure, and combining the plan with a reduction in sodium intake produces additional blood pressure reduction," report Drs. Randy Wexler and Glen Auckerman of Ohio State University.

2. Exercise.

There's evidence that exercise slightly lowers blood pressure. It can also make weight loss easier, even if you don't reduce calories. People who exercise burn calories more efficiently. Moreover, working out can set the tone for other healthy habits.

3. Watch salt/sodium intake.

Salt raises blood pressure in some people. African Americans may be especially salt-sensitive. Recent evidence suggests that salt sensitivity can be a very important determinant of future high blood pressure and cardiovascular disease risk. The U.S. Department of Agriculture's 2005 dietary guidelines recommend limiting sodium intake to no more than 2,300 mg per day.

4. Get more potassium.

The recommended daily intake of potassium is 4,700 mg, according to the Institute of Medicine, but Americans average about 2,000 mg less than that. Adequate potassium is associated with reduced blood pressure. Some salt substitutes are a combination of salt and potassium; they can be a source of additional potassium and lower the sodium in your diet.

According to Drs. Wexler and Auckerman, "Vitamin C, omega-3 fatty acids, coenzyme Q10 and magnesium have been purported to reduce blood pressure. However, their use in management of hypertension is not recommended because of the lack of data from well-designed randomized controlled trials."

5. Drink alcohol in moderation.

Men should consume no more than two alcoholic drinks daily, and women should consume only one. One drink equals 12 ounces of beer, 4 or 5 ounces of wine or one 1.5-ounce shot of 80-proof liquor, all of which supply about 0.5 ounce of alcohol.

In studies, moderate amounts of alcohol have been shown to be heart-healthy.

Moderate alcohol users have higher HDL ("good") cholesterol and better cardiovascular prognoses than people who don't drink at all. But a person who chronically consumes three drinks a day will experience a rise in blood pressure. People who have a family history of alcoholism or addiction shouldn't drink at all.

6. Don't smoke.

The cost and the cure

AHA has estimated that the cost of heart disease and stroke in the United States last year was more than $448 billion, including health care expenditures and lost productivity from death and disability. As the population ages, the economic impact of cardiovascular diseases on our nation's health care system will become even greater.

The cure for hypertension is prevention and early detection. Screenings that help employees identify whether they have, or are at risk for, hypertension, educating them about healthy lifestyles and offering drug benefits that make medication affordable will go a long way toward achieving it.