Pressure tactics

Updated: Apr 27 2008, 05:48am hrs
As with cholesterol levels, the concept of a normal blood pressure has fallen strikingly as doctors learn what it takes to preserve good health. Decades ago, for example, my brother, Jeff, who had high blood pressure that hovered between 160/80 and 170/90, would have been considered normal.

Lacking good treatments for hypertension, no doctor was concerned when, at age 57, President Franklin D Roosevelts blood pressure was 170/90. And so the presidents blood pressure rose inexorably over the next six years, and on April 12, 1945, at age 63 and with a pressure of 200/110, he died of a brain hemorrhage caused by severe hypertension.

But in 2000, when Jeff was 54, his cardiologist knew better. Now with excellent treatments an elevated pressure can be lowered to normal in most people.

Jeffs treatment evolved until he was taking a daily three-pill cocktail Diovan HCT, a combination of a diuretic and angiotensin II receptor blocker; Norvasc, a calcium channel blocker; and Toprol XL, a beta blocker. He also works out on a treadmill and eats a mostly heart-healthy diet, including five to 10 servings of fruits and vegetables a day, whole grain breads, non-fat milk and no added salt. With his blood pressure now at 106/66, the low end of normal, my brother has thus far escaped a premature coronary death.

Hypertension, once known as the silent killer, is now not so silent. Through campaigns urging doctors to check patients pressure at every visit, most cases have been detected. Although treatment has been prescribed for nearly all people known to have blood pressures consistently above 140/90, now called the high end of normal, up to half of the patients still have elevated pressures.

Still a Common Problem

A new report from the American Heart Association describes untreated hypertension as now particularly serious among women. Midsection obesity, an important risk factor for hypertension, is found in 79% of hypertensive women as against 64% of hypertensive men. About a third of hypertensive women have blood pressure controlled at optimal levels, 120/80 or below.

The problem is particularly common among women taking oral contraceptives, whose risk of hypertension is two to three times as high as that of women their age who use some other form of contraception or none at all.

Hypertension is one of the nations most common life-threatening diseases and as many as 66% of people 60 and older have elevated pressures that warrant treatment. An increase in blood pressure with age is common only in developed countries, largely a result of a rich and salty diet, overweight and inadequate exercise. In addition to heart attacks, untreated or inadequately treated hypertension can cause strokes, congestive heart failure, kidney failure and diabetes. While weight loss and improvements in diet and exercise habits can indeed help people lower an elevated pressure, most people cant adjust their lifestyles enough to normalise their blood pressure, Dr Marvin Moser of the Hypertension Education Foundation in NY said.

Difficulties of Following a Diet

One problem with a drug-free approach is the difficulty many patients have in adopting and sticking with a diet and exercise program that can significantly lower their pressure. Data from the latest national nutrition survey, described in the February issue of The Archives of Internal Medicine, said that a diet called DASH that effectively lowered blood pressure was poorly followed by people with hypertension. This diet is rich in fruits, vegetables and low-fat dairy products, a mix that provides excellent sources of fibre, potassium, magnesium and calcium. It is most effective with a salt intake of about 1,500 milligrams a day.

But the new report found that in the years since, instead of improving, the dietary quality of people with hypertension has diminished. Still, as my brothers case showed, even with a good diet, exercise and a healthy weight, most hypertensive patients need medication to achieve an optimal blood pressure. Moser urged people whose blood pressure is higher than 140/90 to ask their doctors, Shouldnt we be doing something else

NY Times / Jane E Brody