|
VICUS.COM (30 Aug. 2000)
-- Between 50 million and 60 million Americans have evidence of
hypertension, the most common clinical condition encountered by
health-care professionals. It is expected this number will increase as
the population grows older and lives longer.
|
High blood pressure
in the United States
High blood pressure (HBP, or hypertension)
was listed as the primary cause of death of 42,565 Americans
in 1997*. HBP was listed as a primary or contributing cause of
death in about 210,000 of the more than 2 million U.S. deaths
that year.
-
About 50 million Americans age 6 and
older have HBP
-
1 in 5 Americans (and 1 in 4 adults) has
HBP
-
The cause of 90%-95% of cases of HBP
isn’t known; however, HBP is easily detected and usually
controllable
-
People with lower educational and income
levels tend to have higher levels of blood pressure
-
Of those with HBP, 26.2% are on
medication but don’t have their HBP under control; and
14.8% aren’t on medication
*Latest date for which data are
available
Source: American
Heart Association, 2000 Heart and Stroke Statistical Update
|
In the past
few years,
there has been a re-analysis of what is considered appropriate therapy
for high blood pressure.
In 1997, the
organization that provides guidelines to primary-care physicians on
the treatment of high blood pressure, the Joint National Committee (JNC)
on Prevention, Detection, Evaluation and Treatment of High Blood
Pressure, asserted that successful treatment of hypertension requires
aggressive blood pressure reduction. Furthermore, it recommended a
more holistic approach that included consideration of concurrent
cardiovascular disease and the presence of risk factors, especially
diabetes, in the treatment approach to hypertension (JNC-VI, 1997).
Then, in
2000, two events further defined what has often been called the
"silent killer." In March, during the 49th annual American
College of Cardiology (ACC) meeting in Anaheim, Calif., a more
holistic approach to treating hypertension was reinforced. During the
update session on hypertension, chaired by Prakash Deedwania, M.D., of
the Veterans Affairs Medical Center/UCSF School of Medicine in San
Francisco, two messages were emphasized:
-
Hypertension
is not just a disease of numbers. Do not focus on blood pressure
values alone.
-
Treat
the whole patient to prevent damage to target organs such as the
heart, brain, kidneys and eyes.
Now, a
clinical advisory statement from the National Institutes of Health,
released on May 4, 2000, states that for middle-aged and older
patients, systolic
blood pressure (the first and higher number in a
blood-pressure reading) is more important than diastolic
pressure (the second and lower number) for diagnosing and
monitoring hypertension. The advisory is summarized below:
-
Systolic
blood pressure should be the principal value for detecting,
evaluating and treating hypertension, especially in middle-aged
and older Americans.
-
Maintain
blood pressure below 140/90 mm Hg throughout one's lifetime to
protect against organ damage.
-
High-risk
conditions, such as diabetes, kidney disease and heart failure,
require more stringent blood-pressure control.
-
Age-adjusted
blood-pressure targets (e.g., systolic blood pressure of "100
plus your age") are unsubstantiated and inappropriate.
Implications
for CAM
According to
the National Heart, Lung, and Blood Institute and the American Heart
Association, only 68% of hypertensive adults in the United States know
they have the condition, and only a little more than half (54%)
receive treatment for it. The unfortunate fact is that only 27% have
their blood pressure under control. The benefits to be realized from
detection and treatment of hypertension are far-reaching.
A holistic
approach to treatment is clearly advocated by opinion leaders in allopathic
medicine.
William
Cushman, M.D., from the University of Tennessee, who spoke at the ACC
meeting, emphasized the importance of lifestyle modification as a
strategy to slow the onset of hypertension. According to Cushman,
lifestyle modification can reduce blood pressure. Among hypertensive
patients, regular exercise (30 minutes four times per week) can reduce
blood pressure by 5 mm to 10 mm Hg. Even in people who are not
hypertensive, this level of activity can lower blood pressure by up to
3 mm Hg.
Other
complementary strategies to recommend for the treatment of the
syndrome known as hypertension include:
-
Weight
reduction of 5 to 10 kg (11 to 22 pounds). This can reduce blood
pressure, especially in patients with borderline hypertension.
-
Avoid
excessive alcohol consumption (more than two drinks/day). There
can be a 1 mm Hg reduction in blood pressure for each
one-drink/day reduction in alcohol consumption, but having more
than two drinks a day is not recommended.
-
Smoking
cessation.
-
Sodium
restriction in diet (especially in certain ethnic groups, such as
African-Americans).
This
article was updated on 30 Aug. 2000.
John
Russo Jr., PharmD, is senior
vice president of medical communications at Vicus.com. He is a
pharmacist and medical writer with more than 20 years of experience in
medical education.
|
References:
American College of Cardiology:
http://www.acc.org/
Framingham Heart Study:
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/fram..html
Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure. The sixth report of the Joint National Committee (JNC-VI)
on prevention, detection, evaluation, and treatment of high blood
pressure. Arch Intern Med.
1997;157:2413-2416.
Kannel WB. Elevated
systolic blood pressure as a cardiovascular risk factor. Am J
Cardiol. 2000 Jan 15; 85(2):251-5.
Kannel WB. The Framingham
Study: its 50-year legacy and future promise. J Atheroscler
Thromb. 2000; 6(2):60-6.
Leonetti G, Cuspidi C, et
al. Is systolic pressure a better target for antihypertensive
treatment than diastolic pressure? J Hypertens Suppl. 2000
Jul; 18(3):S13-20.
Lloyd-Jones DM, Evans JC, et
al. Differential impact of systolic and diastolic blood pressure
level on JNC-VI staging. Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 1999
Sep; 34(3):381-5.
Millar JA, Lever AF.
Excess mortality associated with increased pulse pressure among
middle-aged men and women is explained by high systolic blood
pressure. J Hypertens. 2000 Aug; 18(8):1155.
National Heart, Lung, and Blood Institute. NHLBI Issues New
Clinical Advisory On Systolic Blood Pressure. 4 May 2000:
http://www.nhlbi.nih.gov/new/press/may04-00.htm
Zaret BL, Moser M, Cohen
LS [eds]. High Blood Pressure. Chapter 12. Yale
University School of Medicine Heart Book. New York (NY):
Hearst Books; 1992.
|
