You couldn’t blame anyone from believing we are living in a dystopian fictional novel right now. 

Dystopia is characterized by cataclysmic events with no hope. The data about COVID-19 is very scary – but fascinating to me because it tells you a lot about how acute disease interacts with chronic disease. The New York Department of health recently released data on comorbidities and COVID-19 deaths.  As of April 6, 2020, 86% of COVID-19 deaths involved at least one comorbidity. According to the latest CDC data, almost 90% of adults hospitalized for COVID-19 infection had one or more comorbidities.  Hypertension is at the top of those lists. One thing that strikes me is that the following top comorbidities all involve blood vessel damage, so hypertension is at the center.  I don’t know how comorbidities are counted, but I will assume incidences of hypertension were missed.  Just because a person is on hypertensive drugs, doesn’t meant they aren’t at risk.  Hypertension damages your blood vessels; drugs help to reduce further damage from high blood pressure, but they don’t repair the damage already done. 

According to the CDC, half of US adults have hypertension or are taking drugs for hypertension.  What’s interesting about this information is that it is self-reported.  “The lack of direct blood pressure measurement makes it impossible to fully assess hypertension prevalence or control.”  In addition, you can’t tell if you have hypertension; it’s surely much higher in the US than is being widely reported.

African Americans get hypertension sooner, and it’s more severe.  In my nutrition class, when I cover hypertension, I have students measure their blood pressure.  Almost no female or white student has it but several of the African American males do, and they were always surprised.  The tragedy is they were mostly under 25 years of age and had no other underlying condition that would predispose them such as obesity.  The widely held belief is it’s primarily genetic, but you don’t see the level of hypertension among first generation immigrants from Africa or the Caribbean.  There’s something about being born in the US that go beyond socio-economics.  If left uncontrolled, these young men would begin having serious health problems in 5-10 years.  The integrity of blood vessels ensures blood, oxygen, and nutrients reach their destination without damaging the inner walls of the blood vessels.  Healthy blood pressure ensures the tiny vessels of the kidney, eyes, heart, and sex organs stay pliable and strong.

To me, the focus should be on blood pressure health – for everyone.  Diabetes, cardiovascular disease, and kidney disease are complex and are not easily explained or managed.  Healthy blood vessels (and the lifestyle factors that keep them that way) would largely eliminate these other conditions and is simple to explain and treat.  The CDC, American Medical Association, American Heart Association, Academy of Nutrition and Dietetics and others in the medical community should fund a major campaign alerting people about the importance of healthy blood pressure – especially in the African American community beginning in high school.  Maintaining a healthy weight is key.  Exercise keeps the blood vessels pliable, helps to maintain a healthy weight, and reduces stress, another risk factor for hypertension.  Diet follows closely behind.  A diet low in sodium (from processed foods) and high in potassium (coming from fresh fruits and vegetables) is the simple solution.  Most people have never heard of the DASH diet, but it’s been a successful diet therapy for hypertension for a long time – lowering it at the same rate as anti-hypertensive drugs without the side effects.  Obviously, the key is to never get hypertension, but then I’m an optimist living in a dystopian world.