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High Blood Pressure: An Elusive Threat

25 percent of Americans get inadequate therapy for hypertension, experts say

SATURDAY, March 19, 2005 (HealthDay News) -- "Blood pressure" -- arguably the two most important words in medicine.

If high blood pressure (hypertension) isn't kept in check, you can almost count on a parade of bad things in your future. The list is long, but try heart attack, congestive heart failure, stroke, and kidney failure, just for starters.

Few conditions as dangerous to your health are so easy to control as high blood pressure, at least for the vast majority of people who have it. Testing for it is quick, easy, and painless, and there are cheap well-tested drugs that generally control it. Lifestyle often contributes to hypertension, and diet or exercise, or both, can reverse it. Yet, widespread control of high blood pressure remains a frustrating and elusive struggle. It's a conundrum.

About 65 million American adults have high blood pressure, according to the National Heart, Lung, and Blood Institute, part of the U.S. government's National Institutes of Health. Despite a steady drumbeat of public health warnings and alerts, about 11 percent of those whose blood pressure is too high aren't on any therapy (special diet or drugs) at all and 25 percent are getting inadequate therapy, according to the American Heart Association. Only 34 percent have therapy that meets their needs.

The blame lies everywhere. For one thing, many people don't get their blood pressure tested. Since hypertension has no symptoms as it goes about its dirty work, people have no idea they are skating on increasingly thin ice. What's more, many people with high blood pressure don't take their prescribed drugs regularly. This is a phenomenon that doctors call noncompliance, short for not complying with medical advice. On the other hand, doctors themselves may be prescribing the wrong drugs, or not combining them properly.

The complex reasons for noncompliance can fill a textbook. But one reason may be that some doctors are quick to prescribe new expensive drugs, which work, rather than older cheap drugs, which also work. Many doctors who specialize in treating high blood pressure agree that there is a place for the expensive drugs, but not for the simple, straightforward, garden-variety kind of elevated pressure. For most of these patients generic diuretics combined with generic ACE inhibitors is sufficient.

Excess weight and hypertension add up to more than the sum of their parts. In other words, they combine for extra trouble. Indeed, excess weight can contribute to high blood pressure, which is one reason that exercising and dieting can help lower pressures. This same regimen helps to control diabetes, which can be worsened by high blood pressure.

Some dedicated people can exercise and diet their way right off hypertension drugs. But that's easier said than done, and it's no universal panacea: Some people with normal weight who exercise religiously have high blood pressure nonetheless.

Another way to reduce blood pressure, at least in those who are salt-sensitive, is to reduce the amount of salt in the diet. Some tout a vegetarian diet to lower blood pressure.

The underlying cause for most high blood pressure is unknown, and its subtle, silent ravages were recognized only a generation ago. Until then, high blood pressure was known as "essential hypertension," meaning a fact of life.

As the population ages, the scourge of high blood pressure will worsen. Nearly all elderly people develop high blood pressure, particularly a form called isolated systolic hypertension. Systolic refers to the first number doctors use when they say, for instance, 125 over 85. Older people commonly develop high systolic pressures isolation, that is, not together with diastolic (the second number) as well.

What's more, there is evidence that the problem is starting at the other end of life, that more and more children are being seen with blood pressures higher than the historical norm. A recent study in the Journal of the American Medical Association found a strong upward shift in the blood pressure levels among 5,582 American children, 8 to 18 years old, who were tracked for the past 16 years. Over the years, the percentage of these children who were overweight rose from 11.7 percent to 16.3 percent.

More information

The American Heart Association has more on blood pressure medications.

SOURCES: Michael A. Fischer, M.D., associate physician, Brigham and Women's Hospital, and instructor in medicine, Harvard Medical School, Boston; Richard Milani, M.D., section head of preventive cardiology, Ochsner Clinic Foundation, New Orleans; James W. Reed, professor, medicine, Morehouse School of Medicine, Atlanta; Lawrence J. Appel, M.D., M.P.H., professor, medicine, epidemiology and international health, human nutrition division, Johns Hopkins Bloomberg School of Public Health, Baltimore; January 2005 Nutrition Reviews: Jan. 15, 2005, The Lancet
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