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Senior Citizen Health & Medicine
High Blood Pressure Afflicts 75 Percent with
Diseases Leading to Cardiovascular Problems
Diabetes, stroke, coronary heart disease patients
make little progress against hypertension
 Dec. 10, 2007 - Nearly three-fourths of American
adults with conditions such as coronary heart disease, stroke, diabetes
or others that raise their risk for cardiovascular complications also
have hypertension (high blood pressure). And, although about 75 percent
of these patients are being treated for hypertension, only about 30 to
50 percent are reaching blood pressure goals.
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Health & Medicine |
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Blood pressure control remains a problem in the
United States and around the world, according to this report in the
December 10/24 issue of Archives of Internal Medicine, one of the
JAMA/Archives journals.
(Read more about High Blood
Pressure below this news article.)
“Recent estimates indicate little change in the
prevalence of hypertension, and, although there seem to be some recent
improvements in treatment and control rates, hypertension in many
persons remains inadequately controlled,” the authors write.
Nathan D. Wong, Ph.D., of the University of
California, Irvine, and colleagues analyzed data from adults
participating in the National Health and Nutrition Examination Survey, a
nationally representative survey conducted by the Centers for Disease
Control and Prevention. In 2003 and 2004, 4,646 adults provided
demographic and socioeconomic information and underwent laboratory and
physiological testing (including blood pressure measurements).
A total of 1,671 (31.4 percent) of the participants
had hypertension, defined as a systolic (top number) blood pressure of
at least 140 milligrams of mercury (130 milligrams of mercury in those
with diabetes or chronic kidney disease) or a diastolic (bottom number)
blood pressure of at least 90 milligrams of mercury (80 milligrams of
mercury in those with diabetes or chronic kidney disease), or as
reporting use of a blood pressure–lowering medication. The condition was
more common in older and black adults. A total of 68.5 percent of those
with hypertension were being treated and 52.9 percent of those had their
hypertension under control.
Overall, 23.1 percent of individuals without
conditions that increase cardiovascular risk such as diabetes, heart
failure and stroke had hypertension, while those with such diseases had
rates of hypertension ranging from 51.8 percent to 81.8 percent.
Specifically, high blood pressure was found in:
● 51.8 of patients with dyslipidemia
(cholesterol disorders that include high cholesterol)
● 61.5 percent of those with the
metabolic syndrome, a combination of disorders that may include
obesity, dyslipidemia and resistance to the effects of the hormone
insulin
● 76.8 percent of those with diabetes
● 81.8 percent of those with chronic
kidney disease
● 69.5 percent of those with stroke
● 71.4 percent of those with congestive
heart failure, which occurs when the heart can’t pump enough blood
to the rest of the body
● 73.7 percent of those with peripheral
artery disease, or narrowed veins or arteries
● 73 percent of those with coronary
artery disease
● 76.9 percent of those with two or
more of these diseases
Among individuals with these conditions, 75 percent
or more were being treated for hypertension, but only one-third to
one-half of those in treatment reached goal levels for blood pressure
(140/90 milligrams of mercury for most patients, or 130/80 milligrams of
mercury for patients with diabetes or chronic kidney disease).
“Moreover, given recently released recommendations
to reduce the blood pressure goal to less than 130/80 milligrams of
mercury for persons with coronary artery disease and other high-risk
conditions, our hypertension control rates would be even lower and a
greater distance from the goal for these persons if the new criteria are
applied,” the authors write.
“Nearly three-fourths of adults with cardiovascular
comorbidities have hypertension,” they conclude.
“Poor control rates of systolic hypertension remain
a principal problem that further compromises their already high
cardiovascular disease risk.”
Several potential explanations exist for the gap
between recommended treatment goals - such as target blood pressure
ranges - and clinical practice, writes Theodore A. Kotchen, M.D., of the
Medical College of Wisconsin, Milwaukee, in an accompanying editorial.
“These reasons may include the complexity or
difficulty of achieving the recommended guidelines, patient or physician
behavior and/or deficiencies in the system of health care,” Dr. Kotchen
writes.
“Developing effective strategies to address the
slow pace of dissemination into health care will require a better
understanding of the potential barriers.”
Editor's Note: This study was supported by a
contract from Bristol-Myers Squibb to the University of California,
Irvine. Please see the article for additional information, including
other authors, author contributions and affiliations, financial
disclosures, funding and support, etc.
About High Blood Pressure from National Heart, Lung
and Blood Institute
Who Is At Risk for High Blood Pressure?
About 65 million American adults—nearly 1 in 3—have
high blood pressure.
In the United States, high blood pressure occurs
more often in African Americans than in Caucasians. Compared to other
groups, African Americans:
● Tend to get high blood pressure earlier in life
● Usually have more severe high blood pressure
● Have a higher death rate from stroke, heart
disease, and kidney failure
Many people get high blood pressure as they get
older. Over half of all Americans aged 60 and older have high blood
pressure. This is not a part of healthy aging! There are things you can
do to help keep your blood pressure normal, such as eating a healthy
diet, maintaining a healthy weight, and getting enough physical
activity.
Your chances of developing high blood pressure are
also higher if you:
● Are overweight
● Are a man over the age of 45
● Are a woman over the age of 55
● Have a family history of high blood pressure
● Have prehypertension (that is, blood pressure
in the 120–139/80–89 mmHg range)
Other things that can raise blood pressure include:
● Eating too much salt
● Drinking too much alcohol
● Not getting enough potassium in your diet
● Not doing enough physical activity
● Taking certain medicines
● Having long-lasting stress
● Smoking (smoking can cause a temporary rise in
blood pressure)
What Is High Blood Pressure?
High blood pressure is a blood pressure reading of
140/90 mmHg or higher. Both numbers are important.
Nearly 1 in 3 American adults has high blood
pressure. Once high blood pressure develops, it usually lasts a
lifetime. The good news is that it can be treated and controlled.
High blood pressure is called the silent killer
because it usually has no symptoms. Some people may not find out they
have it until they have trouble with their heart, brain, or kidneys.
When high blood pressure is not found and treated, it can cause:
● The heart to get larger, which may lead to
heart failure.
● Small bulges (aneurysms (AN-u-risms)) to form
in blood vessels. Common locations are the main artery from the heart
(aorta); arteries in the brain, legs, and intestines; and the artery
leading to the spleen.
● Blood vessels in the kidney to narrow, which
may cause kidney failure.
● Arteries throughout the body to "harden"
faster, especially those in the heart, brain, kidneys, and legs. This
can cause a heart attack, stroke, kidney failure, or amputation of part
of the leg.
● Blood vessels in the eyes to burst or bleed,
which may cause vision changes and can result in blindness.
What Is Blood Pressure?
Blood is carried from the heart to all parts of
your body in vessels called arteries. Blood pressure is the force of the
blood pushing against the walls of the arteries. Each time the heart
beats (about 60–70 times a minute at rest), it pumps out blood into the
arteries. Your blood pressure is at its highest when the heart beats,
pumping the blood. This is called systolic (sis-TOL-ik) pressure. When
the heart is at rest, between beats, your blood pressure falls. This is
the diastolic (di-a-STOL-ik) pressure.
Blood pressure is always given as these two
numbers, the systolic and diastolic pressures. Both are important.
Usually they are written one above or before the other, such as 120/80
mmHg (measured in millimeters of mercury, a unit for measuring
pressure). When the two measurements are written down, the systolic
pressure is the first or top number, and the diastolic pressure is the
second or bottom number (for example, 120/80). If your blood pressure is
120/80, you say that it is "120 over 80."
Blood pressure changes during the day. It is lowest
as you sleep and rises when you get up. It also can rise when you are
excited, nervous, or active.
Still, for most of your waking hours, your blood
pressure stays pretty much the same when you are sitting or standing
still. That level should be lower than 120/80 mmHg. When the level stays
high, 140/90 mmHg or higher, you have high blood pressure. With high
blood pressure, the heart works harder, your arteries take a beating,
and your chances of a stroke, heart attack, and kidney problems are
greater.
What Is Normal Blood Pressure?
A blood pressure reading below 120/80 mmHg is
considered normal. In general, lower is better. However, very low blood
pressure can sometimes be a cause for concern and should be checked out
by a doctor.
More information at
http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html
Additional information about treatments for
hypertension can be found at
www.fda.gov/fdac/features/1999/499_hbp.html.
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