From Our 2003 Archives

The New Normal in High Blood Pressure

New Guidelines Target Hypertension Before It Starts

By Jennifer Warner
WebMD Medical News

Reviewed By Michael W. Smith, MD

May 14, 2003 -- Nearly one in four adults in the U.S. who once thought they had normal blood pressure levels are now considered part of a new risk group category called "prehypertension," according to new federal high blood pressure guidelines announced today.

The new prehypertension category includes about 45 million men and women who have a systolic blood pressure (the top number) between 120 to 139 mm Hg or a diastolic blood pressure (the bottom number) of 80 to 89 mm Hg.

The WebMD Weight Loss Plan
For People With Hypertension

By Kathleen Zelman, MPH, RD, LD
WebMD Weight Loss Clinic Registered Dietitian

The WebMD Weight Loss Clinic Program can work well for people on a low-salt diet, as long as the sodium restriction is not severe (less than 2,000 mg per day).

Making the right choices within your food plan -- such as avoiding processed foods and using little table salt -- is the key to making it work for you. Also, keep in mind that sodium occurs naturally in some foods, such as meats, breads and dairy products.

Remember, though, that the salt shaker is usually responsible for only about 15% of the sodium in your diet. Most comes from processed and canned foods, so pass up these foods in favor of fresh ones -- usually those located around the perimeter of the grocery store.

Learn more in Kathleen Zelman's article: Lowering Blood Pressure: It's a 2-Step

Although officials do not recommend that people who fit into this prehypertension category start taking blood pressure-lowering drugs, they do call for these people to make heart-healthy lifestyle changes to reduce their risk of heart disease, stroke, kidney damage, and other complications.

The new recommendations also call for wider use of diuretics ("water pills") for people with high blood pressure -- blood pressure levels above 140/90 mm Hg. They also recommend combination treatment using more than one blood pressure drug for people with severe high blood pressure -- blood pressure of 160/100 or higher.

It's the first major revision of national blood pressure guidelines since 1997. The new guidelines will also appear in the May 21 issue of the The Journal of the American Medical Association.

Researchers say the revisions were necessary because recent studies have shown that by age 55, men and women who don't already have high blood pressure have a 90% chance of developing it later.

"In addition, we have found that damage to arteries begins at fairly low blood pressure levels -- levels which were previously considered 'normal,'" says Aram Chobanian, MD, chair of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, which compiled the report.

Chobanian says research has shown that the risk of death due to heart attack and stroke increases rapidly with rising blood pressure levels, starting at levels as low as 115/75 mm Hg. For every 20/10 mm Hg rise in blood pressure above this level, the risk of death from heart problems doubles.

That's why the report recommends people who fall into the new prehypertensive category make healthy lifestyle changes to lower their blood pressure and prevent the development of high blood pressure. Those steps include:

  • Losing weight if you are overweight
  • Getting regular exercise
  • Adopting the DASH (dietary approaches to stop hypertension) eating plan that emphasizes a low-fat and low-salt diet rich in fruits and vegetables
  • Cutting back on salt
  • Limiting alcohol consumption
  • Quitting smoking

"The implications and potential benefits of such healthier lifestyles could be great, particularly since about 22% of the adult population falls into the prehypertensive category," says Chobanian, who is also dean of the Boston University School of Medicine. "In fact, the blood pressure effects of weight reduction or adoption of the DASH eating plan can be comparable to those achieved with any single blood pressure medication."

According to a national survey, only 70% of Americans are aware that they have high blood pressure, only 59% are currently being treated for it, and only 34% have their high blood pressure under control.

A recent study compared diuretics with other types of blood pressure-lowering medications and found the diuretics were just as effective as the newer drugs in preventing heart attack or death due to heart disease. The new guidelines say these inexpensive drugs should be used as first-line treatment for most people who have high blood pressure without other risk factors such as heart failure, history of heart attack, diabetes, or kidney disease.

New Blood Pressure Guidelines
(top number)
(bottom number)
120 or lower
80 or lower
120 - 139
80 - 89
140 and higher
90 and higher
Blood pressure can be managed through lifestyle changes.

Although the guidelines do not change the traditional definition of high blood pressure, they do call for more aggressive treatment of the condition through the use of a combination of blood-pressure lowering medications. In fact, they say that most people with high blood pressure will require two or more drugs to achieve a blood pressure goal of less than 140/90. The blood pressure goal in people with diabetes or kidney disease should be less than 130/80.

But not all blood pressure specialists completely agree with using combination treatment right off the bat.

"I think the goal of all treatment is to get the right drug for each person and get them on [one drug]," says John Laragh, MD, of the Cardiovascular Hypertension Center at New York Hospital/Cornell University Medical Center. "The more drugs you take, the more side effects, the more cost, and the more nuisance."

Laragh says diuretics, which work by increasing urine production, are only effective in treating people who have salt-sensitive forms of high blood pressure. He says if this type of drug does not produce results initially, other blood pressure-lowering medications should be tried rather than just adding on additional drugs.

"I do believe it is possible to find the right drug for many patients," Laragh tells WebMD. "By trial and error, just giving one drug at a time and testing it, you'll screen out some people who aren't salt-sensitive."

But federal officials say that regardless of the means, the main goal of the new guidelines is to help more people get their blood pressure under control by creating a treatment strategy with their doctor.

"The recommendations are neither a policy nor a prescription for physicians," says Claude Lenfant, MD, director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. "Nobody is advocating some sort of cookbook medicine. The physician will have to decide whether this medication or that medication is the best depending on many considerations."

SOURCES: The Journal of the American Medical Association, May 21, 2003. Aram Chobanian, MD, dean, Boston University School of Medicine and chair of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Claude Lenfant, MD, director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Edward Roccella, PhD, MPH, coordinator of the National High Blood Pressure Education Program at NHLBI. John Laragh, MD, Cardiovascular Hypertension Center at New York Hospital/Cornell University Medical Center and editor-in-chief of the American Journal of Hypertension. WebMD Medical News: "Diuretics Best for High Blood Pressure."

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