How well are we doing nationally with control of hypertension? Better than in past years but, unfortunately, there is plenty of room for improvement. We need your help to achieve higher rates of blood pressure control and hypertension prevention locally and nationally. The most recent national data indicate that about 34% of people with hypertension have their blood pressure controlled to recommended levels of less than 140/90 mm Hg. Although national blood pressure (BP)-control rates were as low as 10% in the late 1970s, current national rates continue to be unacceptably low.

In order for the nation's health efforts to be effective, we need your help as committed colleagues and collaborators. In order to achieve practical hypertension control goals, we must work collaboratively at multiple levels. All of us as individuals must practice what we preach and, where possible, adopt and maintain healthy behaviors that have been shown to prevent hypertension, delay its onset, or contribute to lowering blood pressure levels in people with hypertension. Obesity and physical inactivity are the two major risk factors for hypertension. Regular physical activity, weight control, lower sodium consumption, eating at least 5 servings of fruits and vegetables daily, smoking avoidance or cessation, and moderate alcohol intake (if that's your preference as an adult), are health behaviors that we all can benefit from.

As a healthcare provider, I know the importance of the role that you play on a regular basis in providing accessible, high-quality care to your patients and respect the fact that your own responsible clinical judgment is the central component of any effort to achieve better BP-control rates. Accordingly, we ask you to review and incorporate the most recent clinical practice guidelines into your practice, be aware of hypertension-related clinical practice quality measures and standards, and continue to work with health systems, health plans, and other institutional level partners to achieve and maintain better BP-control rates.

We ask you to help meet two broad challenges on behalf of this country: 1) effective translation of that which we know can work, based on scientific evidence in the form of guidelines, into that which we know is working, based on adoption, implementation, and evaluation of effective hypertension-reducing activities at multiple levels within the community; and 2) sustainability of positive results or outcomes for BP control and hypertension prevention.

The President and this Department are fully committed to achieving better prevention and control of higher-than-optimal blood pressure and recognize your accomplishments in this area and the continued need for your help in achieving local and national blood pressure goals. Thank you for continuing to do what you do best.

RADM Cristina V. Beato, MD
Acting Assistant Secretary for Health
Office of the Secretary's Office of Public Health and Science
US Public Health Service
US Department of Health and Human Services

Dr. Lishan Aklog, Associate Chief of Cardiac Surgery at The Mount Sinai Medical Center, has been named as one of The Top Black Doctors in New York by The Network Journal, a magazine dedicated to educating and empowering Black professionals and small business owners.

Dr. Aklog, 38, is the only heart surgeon named and is one of only five doctors selected to be profiled. "I am honored that The Network Journal Magazine has chosen to include me on this prestigious list amongst such an esteemed group of African-American physicians," said Dr. Aklog.

Since being recruited to Mount Sinai Medical Center from Harvard Medical School's faculty just over 2 years ago, Dr. Aklog has been listed in New York Magazine's Top Doctors, as well as in their special issue on Top Minimally Invasive Surgeons. He has also been cited in Castle Connolly's America's Top Doctors, Strathmore's Who's Who and most recently in Good Housekeeping's list of Top Heart Doctors for women.

Dr. Aklog specializes in the surgical treatment of all types of heart disease but is particularly passionate about the increasing role of new technologies which facilitate performing "minimally invasive" procedures. He is a nationally and internationally recognized expert on this type of surgery, which aims to correct heart problems and relieve suffering through smaller incisions and results in less trauma and a more rapid recovery for the patient. He lectures extensively on this topic and directs courses to teach other surgeons these new techniques.

"Heart disease is currently the number one killer in America, and heart surgery is our most common major surgical procedure, with over 500,000 surgeries performed each year," said Dr. Aklog. "Despite the fact that African-Americans are disproportionably affected by this epidemic, we are 30%-60% less likely to receive life-saving treatments such as heart surgery, even after taking into consideration factors such as socioeconomic status. This was recently highlighted in a landmark report on racial disparities in health care by the Institute of Medicine." He added that, "Without proactive solutions, these disparities are likely to widen as we push the technologic envelope with new costly devices."

Dr. Aklog's academic and clinical pedigree is remarkable. He was born in Ethiopia, one of the world's poorest nations, into a family of considerable prominence and achievement. His father was the country's first cardiologist, and his mother was the country's first woman to receive a graduate university education, at Harvard. Two years after arriving in the United States, fleeing political violence in his country, Dr. Aklog enrolled at Harvard College at the age of 15. He continued on to Harvard Medical School where he received his medical degree and completed his clinical training in cardiothoracic surgery before joining the Harvard faculty as its youngest heart surgeon ever.

Soon afterwards, Dr. Aklog joined the first wave of heart surgeons to embrace "off-pump" or "beating-heart" coronary bypass surgery, which eliminates the need to stop the heart and put the patient on a heart-lung machine. Today, he performs this surgery on nearly every bypass surgery patient. Dr. Aklog was also one of the first few surgeons in the United States to use surgical robots in patients undergoing heart surgery. The robot does not perform the surgery but enables the surgeon to work with better precision in tightly confined areas, making the most of evolving minimally invasive techniques. Other high-tech tools is his armamentarium include "anastomotic devices" which automatically connect blood vessels on the heart without using sutures and a high-powered laser which can offer relief to patients who are not candidates for bypass surgery or stents.

ISHIB congratulates Dr. Aklog on his accomplishments and the role they play in reducing the disproportionate burden of heart disease in ethnic minority populations

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A recent study by researchers at the University of North Carolina at Chapel Hill and the North Carolina Department of Health and Human Services investigated HIV infection among college students in North Carolina. Investigators reviewed state HIV surveillance records for all new diagnoses of HIV infection in men younger than 30 years old living in North Carolina. They characterized all patients diagnosed with HIV infection between January 1, 2001, and May 1, 2003, and their contacts.

Of 423 new diagnoses of HIV infection in men in the period studied, 56 (13%) were in men attending 28 colleges. Of these 56 HIV-positive college men, 88% were African American, and 91% were men who have sex with men or men who have sex with men and women. In the United States, black Americans account for 54% of all new HIV infections, although they make up only about 12% of the general population. Black women are 23 times more likely to have AIDS than white women.

The abstract "Transmission on Campus: Insights from Tracking HIV Incidence in North Carolina" (abstract #84) by L.B. Hightow et al. was presented at the 11th Conference on Retroviruses and Opportunistic Infections, February 8-11, 2004, in San Francisco, Calif. Text of the abstract is available at http://www.retroconference.org/2004/cd/Abstract/84.htm.

Hot Links!

The Washington Post recently published a thoughtful discussion of the issue of health disparities and our government's less-than-aggressive approach to acknowledging the problem.
Click here to read the article.

How much do you know about myocardial infarctions? Take this quiz from heartcenteronline.com and find out.
Click here to take the quiz.

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