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Revised
blood pressure guidelines raised alert level for many
Aug. 25, 2003
By PEGGY O’FARRELL
The Cincinnati Enquirer
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Dr.
T. J. Redington, right, checks the blood pressure
of patient Natosha Chandler, left, during an exam
for her hypertension at the Lincoln Heights Health
Center in Cincinnati on Friday, Dec. 1, 2000.
The clinic is starting a new program to help better
manage common chronic illnesses such as diabetes,
asthma, hypertension, and depression. (Gannett
News Service, Michael Snyder/Cincinnati Enquirer)
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Millions
more Americans may have had “the talk” about
diet and exercise with their physicians after the recent
release of new guidelines that establish a warning zone
for high blood pressure.
The
good news, experts say, is that the new guidelines will
force doctors and consumers to take more aggressive
action against the threat of high blood pressure and
its consequences — heart disease, stroke and kidney
failure.
The
bad news is that consumers don’t want to take steps
to control blood pressure now, so asking them to work
harder won’t be an easy sell.
| BY
THE NUMBERS |
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Blood
pressure by the numbers
Blood pressure measures the force
of blood against the arterial walls,
and is expressed in two numbers. The
systolic pressure, or top number,
measures the force as the heart beats.
The diastolic pressure, or bottom
number, measures the force as the
heart relaxes between beats. A person’s
blood pressure would be expressed,
for example, as 120 over 80 millimeters
of mercury (the measurement scale
used on a sphygmomanometer —
sometimes call a sphygmometer —
or blood pressure cuff).
What
can you do?
Changes to lower blood pressure:
— Follow a healthy diet high
in fruits, vegetables and grains,
and low in fat.
— Reduce salt and sodium in your
diet.
— Maintain a healthy weight for
your height.
— Exercise regularly.
— Limit alcohol intake.
— Stop smoking.
Source: The National Heart, Lung
and Blood Institute
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“Everybody’s
compliant after the heart attack or stroke,” says
Dr. Keith Melvin, an internist with Alliance Primary
Care in Cincinnati. “Prior to that, most people
figure it’s going to happen to the other guy.”
A
blood pressure of 140/90 millimeters of mercury is still
considered high. But the federal guidelines announced
in May and outlined in the Journal of the American Medical
Association establish “prehypertension” blood
pressure levels to indicate that someone doesn’t
have high blood pressure, but is likely to in the future.
Someone whose blood pressure measures between 120/80
and 139/89 is now classified as prehypertensive and
should be counseled to make lifestyle changes to prevent
high blood pressure. “Normal” blood pressure
is classified as anything under 120/80.
The higher a person’s blood pressure is, the more
likely he or she is to suffer a heart attack or stroke,
says Dr. Mark Bibler, an internist with the University
of Cincinnati.
“What’s changed is a greater awareness that
even blood pressure as low as 120/80 has a greater risk
of heart disease or stroke than, say, a blood pressure
of 110/70,” Bibler says.
Hypertension is called the “silent killer”
because it has no symptoms. Most people with high blood
pressure feel just fine until they suffer a heart attack
or a stroke or their kidneys begin to fail.
An estimated one in four Americans has high blood pressure,
and, though the condition can’t be cured, it can
be controlled with medication and lifestyle changes.
Thomas Stone, 50, learned he had high blood pressure
when he went to a health fair a few years ago.
He began taking medication, cut out salt and caffeine
and started exercising regularly. He also started using
lots of fresh garlic when he cooks to help control his
blood pressure. But even with all this hard work, his
most recent blood pressure reading was 126/89 —
still too high by the new standards.
Controlling hypertension isn’t always easy, doctors
say. Many patients, including Stone, need more than
one medication. Stone takes three.
The medications can cause side effects, including fatigue
and frequent urination, that make patients feel worse
than they did before they started taking the medicine.
Those side effects, not to mention the cost, often lead
patients to stop taking their medication.
“Then they’re at the same risk they were all
along. It’s very difficult,” Melvin says.
The guidelines urge doctors to be more aggressive in
prescribing medications, pointing out that about two-thirds
of the people who have been diagnosed with high blood
pressure don’t have it under control.
The new rules also emphasize the use of diuretics, “which
are effective, safe and cheap,” to treat hypertension,
says UC kidney specialist Dr. Max Reif.
The guidelines, established by the National High Blood
Pressure Education Program Coordinating Committee, represent
a major change in mindset for physicians, Melvin says.
“For years, we’ve been concentrating on keeping
the top number under 140, and we’ve had that number
set too high.”
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