Abstract-Therapeutic inertia (TI), defined as the providers' failure to increase therapy when treatment goals are unmet, contributes to the high prevalence of uncontrolled hypertension (Ն140/90 mm Hg), but the quantitative impact is unknown. To address this gap, a retrospective cohort study was conducted on 7253 hypertensives that had Ն4 visits and Ն1 elevated blood pressure (BP) 1999 -2000. 2,3 Despite an increase in the number and tolerability of antihypertensive medications, goal BP has been difficult to attain. Clinical trials, including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack trial, 4 with 66% control rates and the Controlled Onset Verapamil Investigation of Cardiovascular Endpoints study 5 with 70% control rates have shown that the BP control rates reported in national data can be substantially improved. Of note, the majority of uncontrolled hypertensive subjects in the United States are older individuals with systolic BP (SBP) 140 to 159 mm Hg who are seen an average of 6 times annually in a primary care setting. 6 Even with substantial reductions in the number of unaware and untreated hypertensive patients, controlling BP in Ն70% of treated patients is a vital component of reaching the Healthy People 2010 goal of controlling hypertension in 50% of all affected patients. 7 Hypertension control rates nearly tripled from 10% in 1976 -1980 to 29% in 1988 -1991. 8 The improvements in hypertension control coincided temporally with a large decline in the age-adjusted rates for stroke and coronary heart disease (CHD).Unfortunately, BP control rates have changed little in the past 15 years, especially in women. Patient factors, such as compliance, 9,10 knowledge, 11 and lack of insurance, 12 and system factors, such as limited access to care and medications 13 and lack of appointment reminders, 14 have been cited for the low rates of BP control. Of note, BP control remains suboptimal in systems such as the Veterans Administration where financial barriers to health care are less. 15,16 Physician factors, such as therapeutic inertia (TI), that is, failure of providers to begin new medications or increase dosages of existing medications when an abnormal clinical parameter is recorded, are becoming more evident. TI represents a significant barrier to better hypertension control. TI impacts not only control of BP but of other chronic diseases, including diabetes mellitus and hyperlipidemia. [17][18][19][20][21][22][23][24] Although data suggest that TI contributes to the high prevalence of uncontrolled hypertension, the quantitative impact is not clear. This article examines the impact of TI on

Background: Diets high in fiber are associated with lower levels of inflammatory markers. This study examined the reduction in inflammation from a diet supplemented with fiber compared with a diet naturally high in fiber. Methods: Randomized crossover intervention trial of 2 diets, a high-fiber (30-g/d) Dietary Approaches to Stop Hypertension (DASH) diet or fiber-supplemented diet (30 g/d), after a baseline (regular) diet period of 3 weeks. There were 35 participants (18 lean normotensive and 17 obese hypertensive individuals) aged 18 to 49 years. Results: The study included 28 women and 7 men; 16 (46%) were black, the remainder white. The mean (SD) fiber intake on baseline diets was 11.9 (0.3) g/d; on the high-fiber DASH diet, 27.7 (0.6) g/d; and on the supplemented diet, 26.3 (0.4) g/d. Overall, the mean Creactive protein (CRP) level changed from 4.4 to 3.8 mg/L (−13.7%; P=.046) in the high-fiber DASH diet group and to 3.6 mg/L (−18.1%) in the fiber-supplemented diet group

The mechanism underlying blood pressure reduction in the high fruits and vegetables arm of the Dietary Approaches to Stop Hypertension (DASH) Study is unknown but may include potassium, magnesium and fiber. This study was designed to separate minerals and fiber from other components of DASH on blood pressure in abdominally obese metabolic syndrome subjects with prehypertension to Stage 1 hypertension (obese hypertensives). Fifteen obese hypertensives and 15 lean normotensives were studied on a standardized usual diet, randomized to DASH or usual diet supplemented with potassium, magnesium and fiber to match DASH, then crossed over to the complementary diet. All diets were three weeks long, isocaloric and matched for sodium and calcium. In obese hypertensives, blood pressure was lower after 3 weeks on DASH than usual diet (-7.6±1.4/-5.3±1.4 mmHg, p<0.001/0.02 and usual diet supplemented (-6.2±1.4/-3.7±1.4 p<0.005/0.06), whereas blood pressure was not significantly different on usual and supplemented diets. Blood pressure values were not different among the three diets in lean normotensives. Small artery elasticity was lower in obese hypertensives than lean normotensives on the usual and supplemented diets (p<0.02). This index of endothelial function improved in obese hypertensives (p<0.02) but not lean normotensives on DASH and was no longer different from values in lean normotensives (p>0.50). DASH is more effective than potassium, magnesium, and fiber supplements for lowering blood pressure in obese hypertensives, which suggest that high fruits and vegetables DASH lowers blood pressure and improves endothelial function in this group by nutritional factors in addition to potassium, magnesium and fiber.

Platelet and white blood cell counts are higher among some insulin-resistant patients and may contribute to atherothromboembolic complications. Metabolic syndrome patients are insulin resistant, often hypertensive, and at high cardiovascular disease risk, yet the relationship of platelets to the metabolic syndrome is unknown. Platelet and white blood cell counts were obtained from 135 volunteers who had measurements of blood pressure, fasting triglycerides, high-density lipoprotein cholesterol, and glucose. A body mass index >30 kg/m2 served as a surrogate for increased waist circumference. Subjects were subdivided into three groups by the number of metabolic syndrome criteria, i.e., no metabolic syndrome risk factor (MS-0; n = 40), one or two metabolic syndrome risk factors (MS1-2; n = 61), and three to five metabolic syndrome risk factors (MS3-5; n = 34). Platelet counts were increased significantly from 226+/-8 to 257+/-8 and 276+/-10 (x10(3)/mm3) in the MS-0, MS1-2, and MS3-5 groups, respectively (p < 0.01), after adjustment for age, gender, ethnicity, total cholesterol, and low-density lipoprotein cholesterol. White blood cell counts were also increased across the three groups (5.4+/-0.2, 6.2+/-0.2, and 6.6+/-0.3 [x10(3)/mm3]; p < 0.01) after multivariate adjustment. Compared with patients with zero to two metabolic syndrome risk factors, metabolic syndrome patients have higher platelet and white blood counts, which may serve as markers of a prothrombotic and proinflammatory state and contributors to atherothromboembolic risk.