The Pressure's On
By: Source: AARP Bulletin Today Date Posted: 2003-09-02 15:40:00-04:00
After achieving impressive gains through the 1980s, Americans are no longer winning the war against high blood pressure, a leading cause of heart disease, stroke and other serious, even fatal medical problems.
While there may be several reasons for the setback, experts make it clear that it will take both doctors and patients to regain the high ground against high blood pressure, or hypertension.
Mounting evidence shows, for example, that many doctors who assess blood pressure readings—120/80 is considered optimal—are paying far too little attention to the importance of the first number representing systolic pressure as the heart beats, focusing instead on the second number denoting diastolic pressure as the heart relaxes.
Nor, studies indicate, are doctors always aggressive enough in treating high blood pressure when it is detected. "We are not paying attention to the right things, and we are not treating well enough the patients who are detected with the problem," says Claude Lenfant, M.D., director of the National Heart, Lung and Blood Institute (NHLBI).
But doctors don't bear all the responsibility for setbacks in combating high blood pressure. Patients also have been lax. While the dangers of the condition have been known and well documented for years, surprisingly large numbers of Americans fail to monitor their blood pressure.
What's more, although the condition can be controlled in the vast majority of cases, many Americans who know their blood pressure is high fail to treat it.
"Most patients with established hypertension do not make sufficient changes [in their behavior], do not take medication or do not take enough medication to achieve control," reports the National Institutes of Health's Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Earlier this year 25 leading medical, patient and government groups formed a coalition—From Awareness to Action: The National Alliance to Reach Blood Pressure Goals—to urge Americans to take high blood pressure more seriously.
It's easy to see why. High blood pressure occurs in some 50 million Americans—or one of every four adults over age 18. Even though it's easy to detect, one-third of those with the condition are unaware they have it.
"Most of the surveys show we are not making a lot of progress in blood pressure control," says Martha N. Hill, director of the Center for Nursing Research at Johns Hopkins University and head of the From Awareness to Action advisory council.
The consequences of this failure are enormous. In 1997 untreated hypertension killed 42,565 Americans—36 percent more than a decade earlier—and contributed to the deaths of another 210,000, says the National Center for Health Statistics (NCHS).
High blood pressure triples a person's chance of developing heart disease, the leading cause of death among Americans, according to the American Heart Association. The condition boosts the chance of stroke sevenfold and the chance of congestive heart failure sixfold. And hypertension can lead to kidney failure, dementia and blindness.
The irony behind these figures is that high blood pressure can usually be controlled. Many people with moderately high readings can resolve the problem through proper diet, weight control and exercise, experts say. This regimen can help medications work better, reduce the amount of drugs required or even eliminate the need to take them.
Since 1991, however, progress has come to a halt, and there are signs that untreated high blood pressure among Americans is re-emerging as a serious problem. Based on a 1991-1994 survey, NCHS estimated the rate of Americans getting effective treatment for hypertension declined by 6 percent.
An optimal blood pressure reading is considered to be 120/80. Any reading higher than 140/90 is considered high, regardless of a person's age. Systolic readings (the first number) of 130 to 139 or diastolic readings of 85 to 89 suggest a person "needs to be watched carefully," the American Heart Association says.
Doctors traditionally assumed diastolic blood pressure is a better indicator of health risks than the more volatile systolic number. But recent long-term studies suggest that a high systolic reading is a more serious warning sign.
The NHLBI's admonition to heed systolic numbers is especially key for midlife and older Americans, since after age 55 diastolic pressure tends to level off or decline while systolic pressure rises with age.
Of course, doctors' interpretations are of no value if people don't get their blood pressure checked in the first place. Yet many people fail to take this basic step. "Because a person with high blood pressure initially has no symptoms, many people don't know how serious it is," the American Medical Association says.
A National Council on Aging survey shows that nearly half of Americans over 50 don't know their own blood pressure numbers, and more than half are unaware of risk factors for hypertension or what their blood pressure ideally should be.
While the causes of hypertension are not perfectly understood, the problem may result from narrowed arteries, an abnormally large volume of blood or an abnormally fast or forceful heartbeat.
Stress often aggravates, but does not cause, high blood pressure. Known risk factors include genetics (if your parents had it, you're more likely to get it, too), race (blacks tend to develop hypertension earlier, for example), excess weight (only a few extra pounds can drive up blood pressure) and lack of exercise.
Age is another factor: The National Center for Health Statistics estimates that hypertension occurs in 60 percent of people ages 65 to 74 and in 64 percent of men and 77 percent of women over 75.
Here are six self-help approaches to aid people—of any age—in combating high blood pressure:
- Exercise 30 minutes a day. Combining it with weight loss delivers an even stronger blow to hypertension.
- Avoid high-fat (especially saturated fat) and high-cholesterol foods; bake, boil or broil instead of frying.
- Eat foods that are high in potassium such as apricots, bananas, cantaloupes, oranges, lima beans, peas and potatoes.
- Limit salt intake to 2,400 milligrams a day.
- Don't drink more than 2 ounces of liquor a day (or two 12-ounce beers or two 5-ounce glasses of wine) if you're a man, half of that if you're a woman.
- Don't smoke.
Sometimes medications are required to bring blood pressure down. The most common drugs are diuretics, which induce the kidneys to flush excess water and sodium from the body, reducing the amount of fluid in the blood and widening blood vessels.
Another group, beta blockers, reduce nerve impulses to the heart and blood vessels so that the heart beats less forcefully. Some drugs work to relax blood vessels or prevent them from narrowing, so the blood can flow more freely and thus lessen the pumping burden on the heart.
While calcium channel blockers are widely used to lower blood pressure, a study by researchers at the Wake Forest University School of Medicine indicates they are less effective than other medications in preventing heart attacks. More will be known after the NHLBI completes its large-scale study of the drug in 2002.
No matter what course of treatment is prescribed, it's important to stick with it, probably for life. "It's really the patient who every day has the job of getting his risk factors under control," says Johns Hopkins' Martha Hill.
This article previously appeared in the AARP Bulletin. Since its original publication, there may have been some medical developments in this area. Therefore, consult your physician for the latest information and advice on treating this particular condition. The information in this article is intended only to describe this medical issue in general terms. This information should not be used as advice regarding your particular condition. Only your physician can give you proper medical advice.
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