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High blood pressure, obesity and other risk factors continue to contribute to high rates of heart disease and stroke worldwide, including in the U.S. where annual deaths from cardiovascular disease are approaching 1 million.

That's according to an exhaustive statistics report released annually by the ·¬ÇÑÊÓƵ that details what's known about heart and brain health.

The "," published Wednesday in the AHA journal Circulation, details the strides made in reducing cardiovascular disease risk – such as the decline in cigarette smoking. But major advances in how to prevent heart disease and stroke have failed to reap the benefits they could, said Dr. Seth Martin, a cardiologist at Johns Hopkins Medicine in Baltimore and chair of the 43-member group that wrote the report.

"We know so much about what works to improve outcomes for patients, but there are still major gaps in translating that into daily practice," said Martin, also a professor of medicine at Johns Hopkins University School of Medicine. "There is a strong need to innovate in our implementation so that we can close those gaps."

Here are highlights from the report about some of the risk factors for cardiovascular disease.

High blood pressure

Nearly half of U.S. adults – more than 122 million – have high blood pressure, also known as hypertension. The condition damages and weakens arteries, making it easier for them to burst or become blocked. That can lead to heart attacks, strokes and other problems.

Blood pressure is considered high in teens and adults when the systolic, or top number, is at least 130 mmHg, or the diastolic, or bottom number, is 80 mmHg or more. Children also can develop hypertension.

Having high blood pressure in childhood can lead to serious health consequences earlier in adulthood, said Dr. Latha Palaniappan, an internal medicine doctor and a professor of cardiovascular medicine at Stanford University in California. Palaniappan is vice chair of the report's writing committee.

"In the long term, we could be starting medications much earlier, and we really have to be on high alert for strokes, heart failure and other issues at an earlier age in the decades to come," she said.

To lower blood pressure, the AHA recommends eating a well-balanced diet that's low in salt, limiting alcohol consumption, staying physically active, maintaining a healthy weight, not smoking, managing stress and taking medication as prescribed.

Physical activity

The report cites data from 2020 to 2021 that showed only 15% of teens met federal physical activity guidelines of an hour or more per day.

Adults are doing better, but still only 1 in 4 meet the guidelines of 150 minutes of moderate or 75 minutes of vigorous physical activity per week, along with muscle-strengthening activities two or more days per week.

Nutrition

"Most of the U.S. population does not follow a healthy dietary pattern," Palaniappan said.

Indeed, among all cardiovascular health measures in the report, diet was one of the worst. On a scale from 0 to 100, diet scores averaged 24 to 48 across various groups based on data from the National Health and Nutrition Examination Survey from 2013 to 2018.

recommend people follow an eating pattern that includes nutrient-dense food and beverages, lots of fruits and vegetables, whole grains, lean protein and nuts and seeds, while limiting sodium, added sugars, saturated fat and alcohol.

Obesity

The report found 42% of U.S. adults have obesity, as well as 20% of children and teens.

"The proportion of people in the U.S. who are overweight or obese has steadily increased in recent years. It's very alarming," Martin said.

"This report tells us we need to promote healthier behaviors starting in youth, and we need to embrace evidence-based weight loss interventions at scale," he said. "Obesity is a big problem that requires multipronged solutions."

Tobacco use

The nation has made significant progress in reducing cigarette smoking, with consistent declines among U.S. youth and adults in recent decades.

But, the report found, many youth have turned to e-cigarettes. Among high school students, 1 in 7 reported using e-cigarettes, particularly the flavored versions, in the last 30 days.

A growing body of research suggests e-cigarettes are harmful to human health and much remains unknown about how they may affect the heart and lungs.

"We need to be very vigilant about the health effects of e-cigarettes," Palaniappan said. "We are trending in the wrong direction."

What's next

Risk factors for heart disease and stroke affect some groups more than others. For example, the frequency of high blood pressure among Black people in the U.S. is among the highest in the world, the report said.

"In terms of cardiovascular risk factors and disparities, there is a clear indicator that we need to redouble our efforts and really build on what's been learned over the last century," Martin said. "But we must also develop new, creative approaches."

And it will be critical to make sure no one is left out of these strategies, Palaniappan added.

"We need to make sure we are reaching every nook and cranny of our population, including rural areas and those in the underserved parts of our country affected by adverse social determinants of health, including lower socioeconomic status and lack of access to education, health care, healthy foods and safe neighborhoods," she said.