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March 20, 2010
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Less is Less: the Undertreatment of High Blood Pressure
It is not that high blood pressure is especially difficult to control. Today's doctors can prescribe a wide range of good, affordable drugs that will lower your blood pressure and help you live a longer, healthier life. The problem is many of them simply don't. Hypertension and History
High blood pressure, or hypertension, has been recognized for as long as blood pressure itself has been measured and understood, that is for more than a hundred years. But it's only in the last few decades that medical experts have understood just how serious a health problem hypertension really is.
As recently as the end of World War II, there was wide disagreement about whether it was a good idea to attempt to lower a person's blood pressure. Some experts argued that raising blood pressure was the body's way of handling various circulatory problems. They thought that treatment might even be dangerous. Medical thinking began to change when one scientific study after another established a clear association among heart disease, stroke, kidney disease and hypertension. The question that remained was whether hypertension was a cause, an effect or merely a condition associated with these health problems. In the 1960s, several large studies settled the question -- hypertension by itself shortens life. Today we can diagnose and treat hypertension fairly easily. Unfortunately, the vast majority of Americans with the condition continue to go untreated. Possibly because many doctors do not take hypertension seriously as a health threat, this is true even for those who are diagnosed. Hypertension Kills
If you look at it in dollars and cents, the fight against hypertension seems impressive. In Y2000, Americans will spend more than $30 billion on drugs to lower blood pressure.(1)(2) Despite this expense, however, most Americans who are hypertensive(3) either go untreated or do not get the most effective treatment available.(4)(5)
How Big Is the Problem?
Blood pressure is measured by two numbers, which are written on top of each other. The top number is called the "systolic" and measures the force of the blood as it is pumped from the heart, while the bottom number, the "diastolic," measures the pressure remaining in the system. Both numbers are measured by how high ( in "mm" or millilmeters) the force can push up a column of mercury (chemical abbreviation "Hg"). Hypertension is usually defined as either a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more.
Under this definition, more than 50 million people in the U.S., or nearly one in four adults, are afflicted with hypertension. And as the large Baby Boom generation ages, these numbers will only get worse. That is because, as we get older, we become more and more susceptible to high blood pressure. 44% of Americans, aged 50 to 59, and 67% of those older than 70 years are hypertensive.(6) What Does This Mean in Terms of Our Health?
Of the estimated one million deaths annually in the U.S. that are attributed to cardiovascular disease (50% coronary heart disease, 16% stroke, 4% heart failure),(7) according to one scientist, "high blood pressure alone is responsible for 40,000 of these deaths." Furthermore, there is a direct correlation between how high your blood pressure is and your risk of stroke.(8)(9) While experts debate whether hypertension can cause kidney failure, there is no doubt that it can accelerate the damage done to the kidney by diabetes and other diseases.(10)(11)
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