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Editorial
October 25, 2004

Today’s AgendaWe Must Focus on Achieving Favorable Levels of All Risk Factors Simultaneously

Arch Intern Med. 2004;164(19):2086-2087. doi:10.1001/archinte.164.19.2086

As experience with control of earlier epidemics has taught us, prevention of mass disease requires a comprehensive national public health policy that is implemented effectively throughout the population. The United States was one of the first countries to develop public policy in response to adverse coronary heart disease and cardiovascular disease (CVD) trends in the 1950s and early 1960s. Under joint leadership, professional, voluntary, and public organizations developed statements and guidelines that identified all major coronary heart disease risk factors and pinpointed approaches to their prevention and control. The National High Blood Pressure Education Program, launched in 1972, emphasized that high blood pressure (BP) was a major unsolved—but addressable—mass public health problem in the United States.1 In time, based on the recognition that the relation of BP to CVD is continuous, graded, and strong over the whole BP range,2 the focus has widened from interest mainly in elevated BP levels to concern also for intermediate levels. Such intermediate BP levels, once considered normal, have been variously termed mild hypertension,borderline hypertension, or high normal. The latest National High Blood Pressure Education Program report—the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure3—adopts a simple and forceful BP classification: normotension (systolic BP <120 mm Hg and diastolic BP <80mm Hg), prehypertension (systolic BP of 120-139mm Hg or diastolic BP 80-89 mm Hg), and hypertension (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg).

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