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September 8, 2004

High Blood Pressure Can Be Controlled, If We Wish to Control It 

Nearly one third of American adults now have high blood pressure, according to a recent government analysis of Census Bureau and other health statistics. The cause is most likely the obesity epidemic and an aging population.

These statistics are particularly discouraging, says Eliseo Guallar, MD, DrPH, because one third of those with high blood pressure don’t know they are suffering from the disorder, and another third, who do know, are either not taking the right medication, not taking enough, or choosing to forego treatment altogether.

High Blood Pressure Controllable

Yet high blood pressure, one of the most significant risk factors for cardiovascular disease and stroke (CVD), is largely preventable, says Guallar, an assistant professor of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Eliseo Guallar, MD, DrPH

Eliseo Guallar, MD, DrPH

“If a person has high blood pressure and we reduce it, he or she will have the same risk of stroke as someone who has never had high blood pressure,” he says. “Lowering blood pressure with medication also reduces your risk of heart disease, although not quite as much as for stroke.”

“This is the big drama of high blood pressure,” says Guallar. “By intervening on the few risk factors that we already know of, we can get a very substantial reduction of the risk for CVD. But seeing that everyone benefits from these interventions is another matter; preventive measures aren’t the priority of most health care people.”

High Blood Pressure and CVD

Guallar and his team are now working to describe the cause-and-effect relationship between blood pressure and CVD. “We need better answers to this question: How low do we have to go with blood pressure?” he says.

It’s a question that has long baffled medicine. Researchers started out defining high blood pressure as a reading of 160/90–95 or higher; that is, a systolic pressure (when the heart is contracting, pumping the blood on through the veins) of 160 millimeters of mercury (mm Hg) and a diastolic pressure (when the heart is relaxing between beats) of 90 to 95 mm Hg. Then, high blood pressure was defined as a systolic reading of 140 or above. Nowadays, says Guallar, “120/80 is considered normal, and a systolic reading between 120 and 140 is defined as pre-hypertension, which should be treated with diet and exercise.”

Guallar notes that the incidence of cardiovascular disease has been falling because of better medications and better treatment of the disease. “Research has now become very advanced,” he said. “In one sense, we know enough right now to solve the heart disease epidemic—the problem is in applying what we already know.” —Rod Graham