Beating High Blood Pressure

April 19, 2002 -- Setting a blood pressure goal and getting there should be just as important to your health as keeping your cholesterol levels under control, say experts. But only one in four people with high blood pressure ever meet their blood pressure goal.

"We need to educate the public and health professionals about blood pressure goals the same way we did with blood [cholesterol]," says Henry R. Black, MD, chairman of the department of preventive medicine at Rush-Presbyterian-St. Luke's Medical Center in Chicago.

Black says millions of people with high blood pressure are at risk of complications such as stroke or heart disease because their doctors aren't treating their high blood pressure aggressively enough.

"I think doctors stop short because they are afraid that adding more drugs might increase the cost or side effects. But that's short-changing the patient," says Black, who spoke this week at a briefing on cardiovascular health in New York City sponsored by the American Medical Association. "If we have a goal to shoot for, it's easier to know when to stop [treatment]."

Black says it's hard to prove that aggressive treatments are any more dangerous to the patient than allowing their blood pressure to remain at unsafe levels (above 140/90 mmHg). Rather than focusing on the number of pills being prescribed, he says doctors and patients should keep their efforts targeted at getting to a safe blood pressure level.

Black says new data from one of his ongoing studies on using goals to drive blood pressure treatment show the method produces much better results than traditional approaches.

By requiring healthcare providers to increase treatment if the participants were not at goal, the study found that 90% of the patients were able to get their diastolic (bottom blood pressure number) under 90 mmHg, and 60% got their systolic (top number) under 140 mmHg. That success rate is several times higher than the national average of only 27% of patients aged 18-74 with high blood pressure who reach their blood pressure goals.

Researchers say public awareness and success in treating high blood pressure is declining, after peaking in the early 1990s. But experts warn that the notion that high blood pressure does not require immediate treatment is misleading and dangerous.

"We didn't always know that the changes in the body that happen with high blood pressure happen quickly,'" says Elizabeth Ofili, MD, MPH, chief of cardiology at the Morehouse School of Medicine in Atlanta. "While the changes are occurring, high blood pressure has no symptoms until the first stroke."

Ofili says many of the 40 million Americans who are untreated or under-treated for their high blood pressure may be under the false impression that blood pressure medications may be dangerous or have bad side effects.

"The newer drugs don't have severe side effects," says Ofili, who also spoke at the briefing. "Many people feel better when they are on the anti-high blood pressure medications that they did without treatment."