By Robert H. Yoe IV, MD, FACC
Nearly half of American adults—48.1 percent or about 120 million people—have high blood pressure, yet only 22 percent of them have it adequately controlled. In 2024, high blood pressure was a primary or contributing cause in more than 680,000 deaths in the United States.
The burden is particularly significant in Alabama. More than 42 percent of Alabama adults reported having high blood pressure in the most recently published state figure. Alabama’s age-adjusted heart-disease death rate was about 11 percent higher than the national average.
One of the biggest mistakes we physicians can make is treating a single blood pressure reading instead of treating the patient. The first thing I do is check the patient’s blood pressure several times and make sure the diagnosis is correct. I then teach patients how to measure it properly at home: sit quietly for five minutes, keep both feet flat on the floor, support the arm at heart level and use the correct cuff size. I ask them to check it in the morning and evening for about two weeks, write the readings in a log and bring that information back to me.
For many patients, we also provide a connected home blood pressure monitor that securely transmits readings directly into our electronic medical record. That allows my team to follow their trends in real time and make decisions based on weeks of information rather than one office reading.
If the blood pressure stays elevated, I will start medication when appropriate. At the same time, we talk seriously about weight loss, regular exercise, reducing sodium, limiting alcohol, improving sleep and treating sleep apnea when it is present. Alabama’s adult obesity rate is tied for the fourth highest in the nation, which makes addressing these related risk factors especially important in our communities. My goal isn’t just to lower a blood pressure reading. My goal is to prevent the heart attack, stroke or heart failure that could happen years from now.
Robert Yoe IV, MD practices cardiology with Birmingham Heart Clinic.