Is Your Blood Pressure Under Control?

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

Aug. 15, 2001 -- Only about one-quarter of people with high blood pressure are taking medication that controls the condition, according to a new study. That leaves a significant number of people at risk for stroke, heart disease, kidney failure, and other health problems that can occur when blood pressure is abnormal.

David J. Hyman, MD, the author of the new study, tells WebMD it's clear that "little or no action" is taken in far too many cases in which people have blood pressures that while not sky-high, are within the range that qualifies for treatment.

Normal blood pressure for adults is approximately 120/80. National recommendations advise doctors to treat blood pressure when it goes above 140/90. Treatment can include dietary changes, weight loss and/or blood pressure-lowering drugs. But many doctors apparently are not treating people with mild high blood pressure, or hypertension, such as those in the 140 to 160 range.

One problem may be that studies now suggest that systolic blood pressure -- the top number -- is a more important risk factor for heart disease and other medical problems than diastolic blood pressure -- the bottom number. But doctors who have been practicing for 20 or 30 years or more were not taught this concept. In fact, it was once accepted that the top number should be approximately 100 plus your age.

Another issue, says Hyman, is that other doctors who are aware of the recommendations to treat blood pressure above 140, believe the benefits of treatment are not clear enough and they are comfortable letting people with mildly elevated blood pressure go untreated.

Hyman, of Baylor College of Medicine in Houston, examined data from more than 16,000 people and found that most people whose high blood pressure was not being adequately treated were 65 years old or older, had health insurance and had seen a doctor at least three times in the past year.

The good news from the study, which appears in the Aug. 16 issue of The New England Journal of Medicine, is that people with high blood pressure apparently are seeing their doctors regularly.

Hyman says people should take those opportunities to become "very active and knowledgeable about their own health and talk to their doctor about what numbers are right for them," because a blood pressure that is normal for one person may put someone else at risk unless it is lowered, Hyman says.

Another expert says some doctors are afraid that aggressively lowering mildly high blood pressure with medication could be dangerous, especially for older people. But, Aram V. Chobanian, MD, says the benefit of bringing blood pressure down to normal is greater than the risk for most people.

The problem, he says, is large studies showing benefits of reducing mildly high blood pressure have not been carried out, despite good evidence to suggest it is important. Chobanian, of Boston University School of Medicine, says treatment is definitely justified if someone has already had a stroke, heart attack, heart failure, or suffers from diabetes.

"The majority of people with systolic hypertension who are older fall into a category where they would deserve treatment because of other risk factors," he says.