1. Burden of Cardiovascular Disease in Mississippi

2. Top Ten Leading Causes of Death in Mississippi, 2007 Source: Mississippi Vital Statistics, 2007

3. CVD Age-Adjusted Mortality Rates, MS vs. US, 1999-2006 Source: CDC Wonder, 2006

4. MS Stroke Rates Sources: Mississippi Vital Statistics, 2007 CDC Wonder 2005 MS BRFSS 2008 2005 MS age-adjusted stroke mortality was 19% higher than US 2008 MS stroke rate was 54% higher than US

5. Risk Factors of CVD, MS vs. US, 2007 Source: MS BRFSS, 2007

7. Adults, NHANES: 2005-2006 Prevalence of Hypertension

8. JNC 7 Classification Chobanian et al. JAMA. 2003;289:2560-2572.

9. NHANES: 2005-2006 Hypertension – Barriers to Control _____________

10. CVD Risk Factors Hypertension* Obesity* Dyslipidemia* Diabetes mellitus* Microalbuminuria or est GFR <60 mL/min Cigarette smoking Physical inactivity Age –> 55 for men –> 65 for women Family hx of premature CVD –< 55 for men –< 65 for women *Components of metabolic syndrome. Chobanian et al. JAMA. 2003;289:2560-2572. NCEP ATP III. 2002. NIH Publication No. 02-5215 – uses earlier age cutpoints.

11. Body Mass Index ( kg/m 2 ) 14161820222426283032 Systolic BP (mmHg) 115 120 125 130 135 140 Jones et al. J Hypertension 12: 1433-1437,1994 Relation Between Adiposity and Systolic BP

12. Epidemiological studies have shown a correlation between body weight and blood pressure 75% of hypertension in men and 65 % in women is associated with excess adiposity Garrison RJ. Prev Med. 16:1987

13. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Childhood Obesity Trends in Blood Pressure Among Children and Adolescents: JAMA;2004:291 Average weight gain of ~2 lbs/yr (~100 kcal/d surplus)

15. A Diet That Reduces Blood Pressure DASH eating –Grains –Vegetables –Fruits –Low-fat dairy foods –Poultry, fish –Nuts, dry beans –Oils –Sweets

16. Ambulatory Blood Pressure in High and Low Salt Diet

17. Less Sodium - More Potassium Sodium: Less than 2300 mg/day (~ 1 tsp); with HTN < 1,500 mg/day Processed Foods 80% Added at Table 10% Cooking 10%

18. Lifestyle Modifications *Dietary Approach to Stop Hypertension

19. Evolution of SBP over the Life Course Green – Desirable BP trajectory Red, Orange – BP trajectories in individuals with multiple RFs

20. Cultural forces Age Body Weight Societal norms Commercial interests Food industry Public policy Genetic Predisposition Dietary Choices LifestylePharmocology Opportunity for Improving Blood Pressure Control

21. The Tide Is Rising! A Bad Situation With the Potential to Get Worse Presents Great Opportunity! Egan. Hypertension. 2004;44:389.

22. Hypertension “Blood pressure that increases the risk for cardiovascular events (disease)” “A level of BP above which treatment does more good than harm”

23. Hypertension Assessment Accurate and Reliable BP Readings

24. 972 million people with HTN worldwide 73.6 million in US with HTN (33% of > 20 years) 53.6 million with preHTN) > 70% of pts with stroke, MI, CHF have antecedent HTN 1/5 deaths related to HTN Heart Disease is #1 cause of death in women in MS Stroke is #3 cause of death in women in MS