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The Hypertensive Will Have Lots of Company

Study finds 90% lifetime risk among middle-aged people

TUESDAY, Feb. 26, 2002 (HealthDayNews) -- Here's something that will come as unpleasant news to many of you middle-aged Americans who think you're in excellent health: There's a 90 percent chance your blood pressure is high enough to require treatment.

That finding comes from the Framingham Heart Study, which has followed thousands of people for decades, and it's something of a surprise to the people doing the study.

Similar studies have put the percentage lower, says Dr. Ramachandran S. Vasan, lead author of the report, which appears in tomorrow's issue of the Journal of the American Medical Association.

"We expected it to be more than 60 percent, but we guessed it would be about 70 percent," Vasan says.

The benchmark used in the study was a reading of 140 over 90 or higher -- not an enormous elevation, but enough to create a significantly increased risk of heart attack or stroke. The people in the report were 1,298 participants in the long-running study, whose ages ranged from 55 to 65 and who all had blood pressure in the normal range in 1976, when the study began.

"The residual lifetime risk for developing hypertension [high blood pressure] for study participants was 90 percent," the journal report says. "Lifetime risk for hypertension was similar for men and women, and did not differ between participants aged 55 and 65 years."

While all the participants started out with blood pressure in the safe range, more than half of the 55-year-olds and about two-thirds of the 65-year-olds developed high blood pressure within 10 years of the study's start.

The researchers compared statistics between this study period and an earlier one, which ran from 1952 to 1975. They found the risk of developing hypertension was unchanged in women, but the risk for men rose 60 percent between the two study periods.

The authors conclude the rising prevalence of obesity, especially among men, is in part responsible.

There is a modicum of good news in the report, Vasan says. The number of people with markedly high blood pressure, 160 over 100 or higher, went down over two decades, probably because the elevation was detected and treated with medications.

"Doctors are detecting and treating people with pressure of 160 over 100," Vasan says. "There still are many with 140 over 90. That is the next frontier."

However, prevention of hypertension is better than treatment, the report says. "The immediacy and the magnitude of this risk should encourage middle-aged, non-hypertensive individuals to adopt lifestyle-related measures for maintaining optimal blood pressure and for preventing the development of hypertension," it says. "The approach of waiting for hypertension to develop, and only then treating the elevated blood pressure is injudicious."

The report is "a wake-up call," says Dr. David A. Meyerson, a cardiologist at Johns Hopkins University and a spokesman for the American Heart Association.

"It is far more beneficial on all levels to delay and prevent disease, rather than playing catch-up once it has already begun to do harm," Meyerson says. "Young and middle-aged populations should start paying attention to their lifestyle now, because the vast majority of us are at risk."

What To Do

Middle-aged people should have their blood pressure checked at least once a year, and get medication if the level is high. To keep it from getting too high, "you should watch your weight, exercise regularly, 20 to 30 minutes at least five times a week, watch the salt content of food, and don't smoke," he says.

To cut your salt intake, pay less attention to the shaker and more to the nutrition labels on processed foods, which are often loaded with sodium.

For a primer on high blood pressure, go to the American Heart Association. A guide to treatment is offered by the National Heart, Lung, and Blood Institute.

SOURCES: Interview with Ramachandran S. Vasan, M.D., associate professor, medicine, Boston University School of Medicine, Boston; David A. Meyerson, M.D., cardiologist, Johns Hopkins University, Baltimore, and spokesman, American Heart Association; Feb. 27, 2002, Journal of the American Medical Association
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