WEDNESDAY, Aug. 15, 2001 (HealthDayNews) -- Here's a logical picture of someone who is sure to have his or her blood pressure under control: an older, health-conscious individual who has health insurance and who sees a doctor regularly.
But in the real-life, logic is a faulty guide, says Dr. David J. Hyman of the Baylor College of Medicine. His analysis of a nationwide health study finds that while that picture accurately describes most of the 10 million or so Americans who have blood pressure higher than the recommended levels -- 140 over 90 -- they still aren't doing what's needed to keep it within bounds.
The study finds that 92 percent of those with uncontrolled high blood pressure, called hypertension, had health insurance and visited the doctor at least four times a year on average.
"Just about every paper written on the subject has the same statistics," says Hyman, associate professor of medicine at Baylor. And just about every paper says the major reason hypertension is so rampant is that people fail to go to the doctor regularly or don't comply with what the doctor orders.
Not so, says Hyman whose analysis of data from the third National Health and Nutrition Examination Survey found one kind of wide-spread hypertension likely will remain uncontrolled because doctors aren't following the latest recommendations about that specific problem.
The problem is systolic hypertension, in which the higher of the two numbers used to measure blood pressure is above the recommended 140 level. The American Heart Association and other health organizations have recommended that doctors concentrate on keeping systolic pressure below 140, rather than emphasizing control of diastolic pressure, the lower number.
That message doesn't seem to have taken hold, says Hyman's report in the Aug. 16 New England Journal of Medicine. "What we point out is that most people with uncontrolled blood pressure have diastolic pressure below the recommended high of 90 but systolic pressure that is mildly elevated, 150 or so."
Hyman says, "doctors will generally react to diastolic pressure but not to systolic pressure, so it is logical that people can have good health care but end up with uncontrolled hypertension, if you use 140 as the control point. This is simply not what practicing physicians seem to be using."
Dr. Aram V. Chobanian, dean of the Boston University School of Medicine and author of an accompanying editorial, says almost all early studies of high blood pressure, starting in the 1950s and running into the 1980s, concentrated on diastolic pressure. Not until 1991 did the first carefully controlled trial begin looking at systolic pressure, he says. In addition, for a long time the prevailing belief was that high systolic pressure in older people was an inevitable result of hardening of aging arteries.
Though that has been disproved, Chobanian says there is a question of "the knowledge base being translated quickly into medical practice." The problem is complicated by the fact that more than one medication often is needed to control systolic pressure, that doctors can be reluctant to prescribe multiple drugs, and that patients often fail to take them regularly, he says.
"This is a huge mission, treating 10 million people, and the medical community needs to be aware of what we are setting out to do," says Hyman.
Chobanian says, "I think a lot of education is involved for the patient and the physician This is work that has to be tended to over a long period of time. Most of these people are old and will have other problems, so it is not a one-item control issue. They need to consider not only blood pressure but also cholesterol, smoking, diabetes, exercise, obesity."
And Dr. Rose Marie Robertson, professor of medicine at Vanderbilt University and immediate past president of the American Heart Association, says a large number of people with high blood pressure aren't old and don't have good medical care.
"I don't think we can ignore those young people who have hypertension and who don't have access to medical care. There is a substantial portion of the population for whom access is not adequate," Robertson says.
What To Do
"People need to talk to their physicians and decide what blood pressure is best for them and what blood cholesterol is best for them," says Hyman. "They need to work on lifestyle and perhaps take multiple medications as needed."
Detailed information about high blood pressure and how to control it is available from the American Heart Association and the National Heart, Lung and Blood Institute.
