USA Today (9/5, Hellmich) reports, “Despite the well-known perils of high blood pressure, more than half of the 67 million American adults who have the condition don’t have it under control, the Centers for Disease Control and Prevention says in a new report out today.”

CDC director Thomas Frieden remarked, “High blood pressure is public health enemy No. 2. There is nothing that will save more lives than getting blood pressure under control.” Frieden “says major progress could be made with pharmacists, nurse practitioners, physicians and other health care providers working together with the doctor ‘as the quarterback.'”

The Hill (9/5, Viebeck) reports in its “Healthwatch” blog that the report found that “high blood pressure contributes to nearly 1,000 deaths per day by increasing the risk of heart disease and stroke. Sixty-seven million Americans have high blood pressure, and of these, 36 million cases are uncontrolled, according to the report. Another 16 million Americans take medication from the condition but still struggle, the report found.” Furthermore, “The CDC estimates that healthcare costs related to high blood pressure top $130 billion annually.”

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC

Hypertension, defined as blood pressure readings over 140/90, has been called the “silent killer” because it can inflict damage without causing any symptoms. Then, all of a sudden, a stroke other complications can occur.

Even readings that are “high normal” (i.e. 120-139/80-89) are associated with increased risk. We wrote about that in our previous article regarding “pre-hypertension.” (see the link below)

Prehypertension Blogfinger article

The official guidelines for physicians as to how to deal with hypertension is found in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.   JNC-7 guidelines      The eighth edition has been delayed.

To stress a few points:

1. Life style changes can control mild hypertension, but drugs are usually necessary while you are attempting to lose weight, exercise, change your diet, etc. Weight reduction is especially effective. The best way to eat for hypertensives is to follow a Mediterranean style diet including limiting sodium to under 1000 mg per day and limiting calories.

The NIH suggests the DASH diet for hypertension. This is what our book says about the DASH  diet:

“The DASH diet is a balanced 2000-calorie diet that is a good compromise between the very low fat diets and the American Heart Association diet. It has been recommended by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH publication # 98-4080). DASH stands for “Dietary Approaches to Stop Hypertension,” a clinical trial that evaluated the management of high blood pressure. The diet was recommended for patients with hypertension, but it is also beneficial in efforts to prevent heart disease and cancer.

DASH supplies 27% of calories from fat (mostly unsaturated) and includes a lot of fruits, vegetables, grains, nuts, seeds, beans as well as small amounts of unsaturated oil such as found in salad dressing, peanut butter and mayonnaise. The DASH diet recommends low fat dairy products such as yogurt as well as increased intake of calcium, potassium and magnesium.”

**From “Prevention Does Work–A Guide to a Healthy Heart.” by Eileen and Paul Goldfinger.

2. Drugs can always be cut back later.

3. Combination medications are often needed. This approach allows the physician to choose drugs that act in different ways to control hypertension. Then the dose can be minimized for each component.

4. Home BP checks are essential to help your doctor achieve control.

5. The goal of treatment is a normal BP reading, but your doctor may have a specific goal for you, so ask about that. For example, in diabetics, the readings are often lowered considerably.  For others, anything under 140/80 might be considered successful by some physicians.

6. There are a number of reasons why BP may not be controlled in an individual with hypertension, including non-compliance (not taking meds), not monitoring the BP readings (some people erroneously think that if they feel well then their BP must be OK), and failure on the part of the doctor to be aggressive with therapy and not following guidelines. Or the patient may have truly “resistant hypertension.”

7. A significant number of hypertensives are resistant to medical therapy. There is a new procedure now available called “renal denervation.” Ask you doctor about this if your BP is not well controlled.

Don’t forget: Hypertension is treatable, and the devastating complications are preventable.