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from The Washington Post
The National Institutes of Health (NIH) plans to send a clinical advisory to 250,000 U.S. health professional warning that millions older Americans are at risk of dangerous complications because many doctors are not properly treating high blood pressure.
The advisory follows new findings from the long term Framingham Heart Study showing the dangers of not treating people with a type of hypertension called elevated systolic high blood pressure. Systolic blood pressure is produced as the heart contracts and pumps blood to the body. It's traditionally expressed as the first or higher number of a blood pressure reading, such as the "120" in the reading "120 over 80."
Until recent years the systolic reading had often not ben considered a significant indicator of blood pressure problem. The government advisory will urge more aggressive treatment of elevated systolic blood pressure.
"The message from this study is that you cannot ignore systolic pressure." Said Claude Lenfant, director of the National Heart, Lung and Blood Institute (NHLBI), which is part of NIH.
An estimated 43 million people in the United States have high blood pressure, according to the National Center for Health Statistics and the prevalence rises with age. At least half of Americans age 65 and older are estimated to have high blood pressure and three o every four in that group have elevated systolic blood pressure. In some ethnic groups, such as African Americans, the rates are even higher.
Left-uncontrolled high blood pressure significantly increases the risk of heart attacks, strokes and kidney disease. It is also a leading cause of congestive heart failure, a chronic condition in which the heart fails to pump efficiently. An estimated 4.6 million Americans suffer from heart failure annually and it is one of the most common causes of hospitalization among Medicare recipients.
Until now, most of the emphasis of blood pressure treatment has been on controlling diastolic blood pressure- the pressure that occurs in blood vessels between heartbeats and the second number reported when blood pressure is given. Keeping diastolic blood pressure in check is the chief way that the Food and Drug Administration judges the effectiveness of new blood pressure medications.
The problem is that diastolic blood pressure generally plateaus after age 60 and usually declines with advancing age- a fact that seems to make it less useful for monitoring the health of older individuals.
Relying on diastolic blood pressure alone to treat those 60 and older is out. Systolic blood pressure is a far more accurate predictor of future heart attacks, strokes, kidney problems and congestive heart failure.
"This is the fire alarm that says, "Let's pay more attention to systolic blood pressure," said Edward J Rocella, coordinator of NHLBI's National High Blood Pressure Education Program.
Doctors long thought that rising systolic blood pressure was an unavoidable consequence of aging and took few steps to keep it in check. The rule of thumb was to take a person's age and add it to 100 to set co-called "normal" systolic blood pressure level. Using that equation, a reading o 180 was considered an acceptable systolic blood pressure for an 80-year-old.
But in 1997, the NIH's Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure issued new guidelines defining high blood pressure as systolic measurements above 140 an diastolic higher that 90. Optimal blood pressure, the committee's report concluded is 120/80 or lower, and it also set other pressure categories including "high normal" blood pressure (130/85 to 139/89), stage 1 high blood pressure 140/90 to 159/99); stage 2 high blood pressure (160/100 to 179/109) and stage 3 high blood pressure (180/110 or higher).
The Framingham study used those guidelines to examine nearly 5,000 men and women whose average age was 58. About 40 percent of participants had elevated blood pressure- that is 130/85 or higher.
The researchers then focused on 1,488 participants with high-normal blood pressure levels who were potentially eligible for drug therapy. Using diastolic measurements, only one-third o these participants would have qualified for blood pressure treatment. But when the team looked at systolic blood pressure levels, 94 percent needed treatment.
"Our data indicates tht systolic blood pressure plays a grater role than diastolic blood pressure in determining both blood pressure stage and eligibility for therapy," the team of researchers led by Daniel Levy concluded.
The importance of systolic blood pressure was also highlighted by another recent study, conducted by the same team of researchers and published in July in the journal Circulation. That study found that the rises of coronary heart disease rose 35 percent for every 10 points of elevated systolic blood pressure. By comparison, the same rise in diastolic blood pressure produced about a 14 percent increased risk, Levy and his colleagues reported.
Based on such findings, "it is no longer permissible for us [or our colleagues or our patients] to think that a systolic blood pressure of 100 plus your age is acceptable," said Henry R. Black, chairman of preventive medicine at the Rush-Presbyterian-St. Luke's Medical Center in Chicago in an editorial accompanied by the study. "Yet many still do not know this, and many have trouble giving up that antiquated idea."
Only about a third of American with high blood pressure are aware of their condition according to the National Health and Nutrition Examination Survey (NHANES), which was conducted from 1991 to 1994 by the US centers for Disease Control and Prevention. Among the 68 percent of participants, who had been diagnosed with high blood pressure, NHANES found that only about half received treatment. Just about a quarter of those reduced their blood pressure to safe levels through a combination of lifestyle changes or drugs.
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