Hypertension redefined: a call for holistic Rx

Hypertension is no longer the ‘silent killer.’ We know too much to ignore this syndrome and its
life-threatening complications.

By John Russo Jr./Vicus.com
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.