SILENT KILLER

May 5, 2000
		Experts scold the medical community for using incorrect standards to monitor high blood pressure and offer new recommendations. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

March 23, 2000: Heart Health Nov. 11, 1999: Ramipril for preventing heart attacks and diabetes. July 20, 1999: Aldactone found surprisingly effective. May 27, 1999: Seeking hospitals for heart care. Nov. 11, 1998: Gains in the fight against Heart Disease. April 13, 1998: Smoking and Heart Disease. June 19, 1997: Estrogen and Heart Disease. April 3, 1997: Heart disease risks. The NewsHour's Health Spotlight. Browse the NewsHour's coverage of Health   NIH press release American Heart Association	SUSAN DENTZER: Most people are used to having a doctor or nurse take their blood pressure. That's one of the so-called "vital signs" of good health. NURSE: It's 150 over 90. SUSAN DENTZER: Those two numbers measure the pressure that blood exerts in the arteries during two different phases of the heart's activity. The first number marks the systolic phase, when the heart muscle contracts to pump blood to the rest of the body. The second number measures pressure during the heart's diastolic phase, when the muscle relaxes. A normal blood pressure is systolic pressure at around 120 and diastolic pressure about 80. By contrast, it's considered high if systolic pressure is 140 or higher, and if diastolic is 90 or higher. HEALTH CARE WORKER: Do you have any blood pressure problems? SUSAN DENTZER: About 50 million Americans have high blood pressure, also called hypertension. The condition can ultimately damage arteries, weaken the heart, and even affect other organs like the kidneys. Untreated, it can lead to heart attack, congestive heart failure, and stroke. Those are among the leading causes of death in America. A growing body of research has shown that an elevated top measurement, or high systolic pressure, is by far the best predictor that any these serious diseases will result. That's especially true for middle-aged and elderly Americans. But even so, for various reasons most doctors have long focused more on the second measurement, the diastolic pressure, to determine whether a patient's blood pressure was high. Yesterday an expert committee appointed by the National Heart, Lung, and Blood Institute in effect scolded the medical profession for not taking systolic pressure more seriously. It issued a special advisory to doctors calling for a "major paradigm shift." That would make systolic pressure the main measurement for determining whether a patient needed treatment.
	More people should be monitoring
	RAY SUAREZ: And we turn to Dr. Ed Roccella, coordinator of the high blood pressure education program at the national heart, lung, and blood institute. He served as executive advisor to the committee that issued the new report. Well, Doctor, should we conclude from this report that there are a lot more Americans out there than realize it who are suffering from high blood pressure? DR. ED. ROCCELLA, National Heart, Lung, and Blood Institute: Well, indeed, Ray. There are many people out there that need to start being concerned about their systolic blood pressure. As we get older, blood pressure begins to rise. Systolic pressure will increase. Thus we'll see more heart attacks, stroke, and kidney failure if we don't pay attention to it. RAY SUAREZ: And this message is going out not only to people who seek treatment but to physicians, too, right? Reminding them that the systolic number should be important to them? DR. ED. ROCCELLA: Indeed. We have a clinical advisory that will be going out to doctors, it's on our Web site, it's going to be published in the journal "Hypertension" this month, in May. The advisory reminds physicians about the ability of systolic blood pressure to predict future strokes, heart attacks, and heart failure. But in addition, we've got good news. There are clinical trial data, evidence that shows the benefits of lowering systolic blood pressure: A 27% reduction in heart attacks, a 37% reduction in strokes, and a 55% reduction in heart failure. That's remarkable data, and good news for practicing doctors.
	Old data, new worry
	RAY SUAREZ: If we know that, and we've known for some time that treating that systolic number was important, why did we have that old idea? Why were doctors telling people leaving their consulting rooms that, "no, don't worry, it goes up with age," that first number? DR. ED. ROCCELLA: Well, we've had some information that shows that indeed systolic pressure does rise with age. And we believed that was a normal part of aging. We were concerned about diastolic pressure. That's the second number, that's the pressure in the arteries when the heart relaxes. We thought of a duration effect, that is, it's a longer time for that diastolic pressure in the arteries, caused more death and disability. But it wasn't until the late 80's that we thought we had some information about the value of lowering the systolic pressure. And when that information came in, we were just astounded in terms of the ability of systolic pressure's lowering effect to prevent death and disability. RAY SUAREZ: So should everybody go running to their doctor tomorrow? DR. ED. ROCCELLA: Well, it's not an emergency situation, but it's something we want people to be concerned about. If your blood pressure isn't less than 140 over 90, ask your doctor why, and what the two of you should be doing about it. RAY SUAREZ: Now, that second number, the diastolic number, also changes with age, too, doesn't it? DR. ED. ROCCELLA: It seems it does change with age. It tails off as we get older. Therein lies one of our other challenges. If we have been concerned about diastolic pressure, and it goes down as we get older, some people have said, "oh, well, the blood pressure problem is resolved. Therefore we should do nothing. Let's just leave grandpa alone because the diastolic is coming down." But we know the value of treating systolic blood pressure now.
	Lifestyle changes and medication
	RAY SUAREZ: So what should someone who is on the bubble, around 140, around 150, what's the first thing they should do? DR. ED. ROCCELLA: We've got some good news. If your blood pressure is around the 140 over 90 level, and you should be working with your doctor, but there's some lifestyle changes that some folks can do that will work to control blood pressure. One, lose weight if overweight. Shedding even ten pounds will help. Two, eat more fruits and vegetables, and reduce salt in your diet. Most Americans consume more salt or sodium than they need. Read food labels, read the packages. That's why those numbers are on the packages, so people can see what they're eating. Three, if you are a couch potato, please get up. 30 minutes, even most days of the week-- that could be two 15- minute walks with your dog-- will help. And if you choose to drink alcohol, do so in moderation -- no more than two drinks a day for men and one for women. RAY SUAREZ: Should you use the lifestyle modification program first, and try to do it that way instead of taking drugs? DR. ED. ROCCELLA: Well, if the lifestyle will work, by all means let's give it a try. Let's really work at it. But if it doesn't, there are a variety of new anti-hypertensive agents that are available. Working with your doctor, a combination of lifestyle changes and drug therapy can help bring that blood pressure down. RAY SUAREZ: How often should you have your blood pressure taken? I mean, for millions of us it's just a normal part of visiting the doctor for any reason. But if you're in generally good health, is there target number of times you should be watching per year? DR. ED. ROCCELLA: We have described that in our clinical guideline, and we say that if your blood pressure is optimal in the 120 over 80 range, then you can go eve two years without having it measured. But if it starts creeping up, you might want to go more frequently. Remember, there is a clear relationship between a rising blood pressure and an increase in cardiovascular events. By that, I mean a heart attack, or stroke, or kidney failure. The higher the blood pressure, the greater the risk. There's nothing magical about the 14over 90. And in the presence of other cardiovascular risk factors-- diabetes, elevated cholesterol, cigarette smoking-- the risks increase remarkably. RAY SUAREZ: Should that number go up from once every two years when you start to get older? DR. ED. ROCCELLA: It wouldn't be a bad idea to have your blood pressure measured on visits to your doctor. RAY SUAREZ: And that would mean, what, once every six months? DR. ED. ROCCELLA: Well, every year, every six months, whenever you get in to see your doctor. Most clinicians will measure your blood pressure on most visits. RAY SUAREZ: So really the report is just a warning, a reminder? DR. ED. ROCCELLA: It's a warning and reminder, but good news -- it's good news that we can do something, and it's a good news remind that by treating the diastolic pressure, as a reminder now, we have been able to reduce death and disability. Since the advent of the national high blood pressure education program administered by the National Heart Lung and Blood Institute in 1972, strokes have declined by 60%. Heart attacks have declined by 50%. But we want to do better, and we can do better by applying this new information to practice. RAY SUAREZ: Dr. Ed Roccella, thanks a lot. DR. ED. ROCCELLA: Thank you.