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Controlling High Blood Pressure: A National Priority?

Controlling hypertension should be a national priority according to an editorial in this week’s New England Journal of Medicine.

Controlling hypertension, otherwise known as high blood pressure, sounds easy enough in today’s advanced world of medicine, but a new study in this week's New England Journal of Medicine points out that of the 42 million people with hypertension in the US, more than one-fourth remain unaware they have the disease, and approximately three-fourths of those who know they have the disease still have blood pressure that exceeds recommended levels. CBS News health contributor Dr. Bernadine Healy talked about the report with the Early Show.

Let's start with the one-fourth of the 42 million who have the disease and don't know about it. How is that possible?

There aren't any real warning signs except perhaps headaches, or in severe cases, headaches accompanied by dizzy spells. In addition, data suggests that some people may not have access to the right type of medical care, or their doctors may not be treating them the right way. Except in young people, systolic blood pressure (the top number) is more important than diastolic blood pressure (the bottom number) as a predictor of whether or not a person might be at risk for cardiovascular disease.

For instance, if you're talking about a normal target blood pressure of 120 over 80, 120 is the systolic number that measures when the heart first pumps. The diastolic number would be the 80 and that number measures the pressure when the heart relaxes. The higher the first number the greater the high blood pressure problem.

What is the most common treatment for high blood pressure?

The first line of treatment is lifestyle modification--exercise, altered diet, and no smoking. The second line of treatment is medication.

What about the alarming three-fourths of people who know they have the disease and yet their blood pressure still remains high. Are they not following doctor’s orders?

Long-term adherence to treatment is a real problem, as is the case with so many chronic conditions. People take the medicine and feel it's under control (since they have no symptoms telling them otherwise) so they decide to stop or skip their medication. (The study showed that approximately half of all patients who are prescribed antihypertensive medication discontinue therapy on their own during the first year of treatment.)

But if a doctor prescribes a medication, shouldn't a patient be aware of the importance it has for their overall health? Are doctors not stressing this enough when writing prescriptions?

Perhaps doctors are not spending enough time talking to their patients about high blood pressure and educating them. In most cases, a patient who is diagnosed with high blood pressure needs to work at changing his or her lifestyle. In addition to taking a prescribed high bloopressure medication, patients should be encouraged to exercise and to follow a diet full of fruits and vegetables and high in potassium and protein. If they are able to follow a regular exercise routine and diet, often they will be able to bring their blood pressure down on its own and the medication will no longer be necessary. Unfortunately, as most of us know, lifestyle changes like exercise and diet are the hardest to follow, so here, the medication would remain vital.

What would happen if someone who didn't exercise and follow a good diet stopped the medication?

These people are putting themselves in a category where they will probably end up with sustained levels of high blood pressure and the real danger here is that this greatly increases a person’s chance of stroke or heart attack over time. The big problem with high blood pressure is that it's sort of like smoking. Just as smoking a cigarette today won't harm you today, high blood pressure for a fedays won't give you a heart attack or a stroke right now. It's the sustained smoking or the sustained elevated blood pressure over time that can put you in serious danger. Given the fact that 25% of young people in our society are smokers, we have to wonder whether we haven't stressed the value of long-term health in this country as much as we should.

What about the cost? Can't that be a factor for some people without insurance for prescription drugs?

Not in this case. The cost of treating this is probably 25 cents a day.
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