Tue, Apr 29, 2008 - Page 16 News List

[ HEALTH ] The Silent Killer

People who have a healthy diet and exercise regularly can still suffer from high blood pressure. Fortunately, early diagnosis and the right drugs can help

By Jane e. Brody  /  NY TIMES NEWS SERVICE, NEW YORK

ILLUSTRATION: NY TIMES NEWS SERVICE

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 US President Franklin D. Roosevelt’s blood pressure was 170/90 when he was 57 years old. And so the president’s 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, most often used in combination, an elevated pressure can be lowered to normal in most people. His doctor said that, with our family’s medical history of three coronaries on our father’s side occurring at ages 56 and 58, something should be done to protect Jeff’s health.

Jeff’s 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 several times a week, runs up and down stairs at home and at work all day, and eats a mostly heart-healthy diet, including five to 10 servings of fruits and vegetables a day, whole grain breads, nonfat 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 US 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 patients still have elevated pressures.

Why? Because doctors are not aggressive and creative in treating the problem; because unlike my brother, many patients do not follow doctors’ orders and fail to fill prescriptions or neglect to take medicine daily; and because the rising weight of Americans and the passion for high-salt processed and restaurant-prepared foods have raised the once-normal pressures of many people to levels that experts say should be treated.

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 percent of hypertensive women as against 64 percent 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 nation’s most common life-threatening diseases, with an overall incidence among adults of nearly 30 percent, a survey of 14,600 people in 2003 and 2004 found. And as many as 66 percent of people 60 and older have elevated pressures that warrant treatment, the survey showed. 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.

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