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Is High-Normal Blood Pressure a Medical Misnomer?
Oct. 31, 2001 -- Some 43 million Americans with high blood pressure are clearly at increased risk for heart attack, stroke, and heart failure. The risk has been less clear for millions of others with borderline high blood pressure, but new research suggests they, too, have cause for concern.
In a study involving participants in the Framingham Heart Study, the risk of heart attack, stroke, or heart failure was roughly twice as high for people with blood pressure readings that were in the high-normal range, compared to people with levels considered to be optimal. The findings are reported in the Nov. 1 issue of TheNew England Journal of Medicine.
High blood pressure is defined in adults as a systolic pressure (top number) of 140 or higher and a diastolic level (bottom number) of 90 or more. The best available data suggest that roughly 13% of adult Americans have high-normal blood pressure, defined as systolic pressure between 130 and 139 and a diastolic pressure of 85 to 89. Those with lower levels have readings considered to be either normal (between 120 and 129 systolic/80 to 84 diastolic), or optimal (a systolic level less than 120 and a diastolic level less than 80).
"This study suggests that high-normal blood pressure is probably closer to high than to normal in terms of risk," Framingham researcher Ramachandran S. Vasan, MD, tells WebMD. "There is a continuum of risk and the higher you are above optimal, the greater the risk of [heart problems or stroke]."
In other words, normal sounds good but is not as good as optimal. And high normal is not normal after all when used to describe blood pressure.
Vasan and colleagues followed approximately 7,000 study participants for an average of 11 years in an effort to determine how their blood pressures affected later heart problems or stroke events. None had high blood pressure at the beginning of the study, but a quarter of participants had high-normal levels.
The researchers reported that those with blood pressures in the high-normal range were 1.5 to 2.5 times more likely to suffer a heart attack or stroke or develop heart failure during a 10-year period than those with optimal readings. The risk was greater for women than for men and was highest for those with other recognized risk factors for heart disease such as advanced age, obesity, and diabetes.
Vasan says clinical trials may be needed to determine whether people with blood pressure levels falling in the high-normal range would benefit from taking medications to lower their blood pressure. Such drugs are now recommended only for those with systolic pressure reading of 140 or more or diastolic levels of 90 or more.
"This study offers compelling evidence that people falling into this high-normal range may benefit from these drugs," says Alberto Nasjletti, MD, chairman of the American Heart Association's council on high blood pressure research. "We know these drugs are effective, but they are widely underutilized in people who have high blood pressure that is not borderline. We have to do a better job of educating patients and doctors that high blood pressure is a serious condition that needs to be treated aggressively."
Vasan and Nasjletti agree that making healthy lifestyle changes is critical for people with any level of high blood pressure. Those changes include reducing the level of fat and salt in your diet, exercising regularly, and losing a few pounds if you are overweight.
"These are simple measures, but it is impossible to overstate their importance," Vasan says.
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