"From other work, we know that young people are least likely to be aware that they have high blood pressure," she said. "If they do have high blood pressure, they are least likely to be in treatment, and if they are in treatment, they are least likely to have it under control."
Young people don't often go to doctors, and "physicians don't often treat high blood pressure in young people, because they think the consequences are far in the future," Bibbins-Domingo said.
The study "suggests that individual patients and their physicians should be aware of the future dangers of high blood pressure and obesity in young people," she said. "They should try for changes in lifestyle, and should put them on medications when lifestyle interventions don't work."
Those interventions are especially important in young blacks, she said, but the message is often ignored. "The high rate of teenage obesity in the black community suggests that we already are behind the curve," Bibbins-Domingo said.
Dr. Paul Underwood, former president of the Association of Black Cardiologists, was struck by "the interplay between high blood pressure and heart failure" shown by the study.
"Fully 40 percent of those in the study were not on hypertensive therapy at the time they were diagnosed," Underwood said.
The study points up the need to identify and control risk factors including obesity and diabetes, Underwood said. "If we don't get control of the situation, it's going to get much worse," he noted.
It's difficult to tell whether racism underlies the differences seen in the study, said Dr. Eric D. Peterson, a professor of medicine from Duke Clinical Research Institute in Durham, N.C., who wrote a commentary accompanying the report.
"That is hard to prove," Peterson said. "It is a diagnosis of exclusion. Patients don't notice a care differential, but when you look at the re
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