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Despite the well-known perils of high blood pressure, more than half of the 67 million American adults who have the condition don't have it under control, the Centers for Disease Control and Prevention says in a new report out today.

"High blood pressure is public health enemy No. 2," behind tobacco, says CDC director Thomas Frieden. "There is nothing that will save more lives than getting blood pressure under control," he says.

"An elevated blood pressure reading is a life-threatening reading and prompt action of some sort needs to be taken."

High blood pressure is defined as a reading greater than or equal to 140/90.

High blood pressure means the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears, the American Heart Association says.

The scar tissue that forms to repair those tears traps plaque and white blood cells, which can lead to blockages, blood clots and hardened, weakened arteries, the heart association says.

Hypertension is a major risk factor for heart disease and stroke, the first and fourth leading causes of death in the USA. This is leading to nearly 1,000 deaths a day every day of the year, Frieden says. The direct cost of high blood pressure is almost $131 billion annually, he says.

The latest government statistics show:

•36 million people have uncontrolled high blood pressure.

•About 26 million with uncontrolled blood pressure have seen a doctor at least twice the past year.

•Nearly 22 million know they have high blood pressure, but don't have it under control.

•16 million take medicine, but still don't have their blood pressure under control.

•14 million are unaware that they have high blood pressure.

When your blood pressure is high, you are four times more likely to die of a stroke and three times more likely to die of heart disease, Frieden says. Even blood pressure that is slightly high can put you at risk.

There are several reasons why people who know they have high blood pressure don't have it under control, Frieden says. The treatment plan either isn't optimal or they are not taking their medication. They may be having trouble paying for it, he says.

Still, "medicine for high blood pressure works for nearly all patients."

By keeping your pressure down, "you are protecting your brain from a stroke and your heart from a heart attack," he says.

He says major progress could be made with pharmacists, nurse practitioners, physicians and other health care providers working together with the doctor "as the quarterback."

"With increased focus and collaboration among patients, health care providers and health care systems, we can help 10 million Americans' blood pressure come into control in the next five years," he says.

Hypertension expert Ernesto Schiffrin, a spokesman for the American Heart Association, says there is still much that can be done to improve blood pressure control and therefore reduce the personal and financial cost to families and the health care system attributable to high blood pressure.

Gina Lundberg, a cardiologist with Emory Healthcare in Atlanta, says people tend to check their blood pressure when they are under less stress and they don't check it when they are stressed out, and that's when it's higher. "So many people don't believe their blood pressure is as high as it is."

To help get their blood pressure under control, patients need to manage their stress, not smoke, maintain a healthy weight, exercise routinely and eat a low-sodium diet, similar to the DASH (Dietary Approaches to Stop Hypertension) diet, she says. Research shows that people can lower their blood pressure by following this low-sodium, high-fiber eating plan, Lundberg says.

It emphasizes fruits, vegetables and fat-free or low-fat milk and milk products and includes whole-grain products, fish, poultry and nuts. It is very low in sweets, added sugars and sugar-containing beverages.

"I tell my patients that salt doesn't just come out of the salt shaker. If food comes in a box, a bag or a can, it may be full of sodium," she says.

And patients need to be sure to take their medication, Lundberg says. "A lot of patients skip their medications occasionally because they forget or get busy. Or they may think the medications have side effects and don't take them for that reason. Or they may not think they can afford them."

But it's critical to take the medications as prescribed, she says.

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