High Blood Pressure

By Jennifer Huget
The Washington Post
Tuesday, January 1, 2002;

U.S. cases: 50 million

Of the major risk factors for heart attack and stroke – which include smoking, diabetes and high cholesterol – high blood pressure is the most easily identified, monitored and treated. But it often goes undetected; when found, it often goes untreated. Last year's National Health and Nutrition Examination Survey found that only one in four Americans with the condition has it under control. Consequently, many resources this year will go toward education, especially for low-income and minority groups that are particularly hard-hit.

Research last year found that even readings in the "high normal" range – a top number between 130 and 139, and a bottom between 85 and 89 – are dangerous. A National Heart, Lung, and Blood Institute (NHLBI) study released in October tied such readings to significantly greater risk of heart attack, stroke or heart failure.

Some experts argued that the top number – the systolic reading, taken when the heart contracts – may better signal high blood pressure than the traditional indicator, the diastolic or bottom number, taken when the heart is relaxed. A recent study suggests that readings taken while exercising rather than at rest are more predictive of early heart disease.

One of the key lifestyle choices affecting blood pressure is diet. An NHLBI study released in December showed that the DASH (Dietary Approaches to Stop Hypertension) diet – rich in fruit, vegetables, grains and low-fat dairy products but light on salt, fat, sweets and red meat – lowers blood pressure for nearly all people. For those who don't follow DASH, a low-sodium diet proved effective in reducing blood pressure.

Key drug advances include findings that blood pressure medications can confer other benefits: the ACE (angiotensin-converting enzyme) inhibitor ramipril also can prevent and reverse enlargement of the heart.