According to two new studies published this past week, hypertension is a much bigger problem for Americans than previously thought. This is because a) the vast majority of Americans who are middle aged and older either have hypertension or will develop it; and b) doctors are failing to treat the hypertension appropriately.
The first study, published in the February 27 issue of the Journal of the American Medical Association, analyzed patients enrolled in the famous Framingham Study and found that 90% of individuals 55 years old or older either have hypertension, or will develop hypertension in the foreseeable future. This estimate is strikingly higher than previously believed.
The second study, appearing in the February 25 issue of the Archives of Internal Medicine, showed that the majority of doctors significantly undertreat their patients with hypertension - especially those with systolic hypertension. (Click here for a review of treatment goals for hypertension, and a definition of systolic and diastolic blood pressure.) Doctors fail to treat hypertension appropriately, the study revealed, even though they are aware of the data showing that hypertension (in particular, systolic hypertension) greatly increases their patients' risk for heart attack, stroke, heart failure, and kidney disease.
Taken together, these studies indicate that most Americans may be at much greater risk for premature cardiovascular disease than they need to be.
The reason for both of these new findings is likely the same: the definition of hypertension has been changed recently. In the past, the systolic blood pressure was not considered "too high" unless it was above 150 or 160 mm Hg. Recently, it has been found that a systolic blood pressure above 140 mm Hg poses a significant increase in risk, and ought to be treated.
This redefinition of hypertension creates many more patients who have hypertension, and thus likely explains the striking results from the first study cited above.
It also likely explains the results of the second study. For, even though the doctors in that study were aware of the "new" definition of hypertension, they generally avoided treating patients unless they fit the old definition. In the opinion of DrRich, this failure most likely represents skepticism on the part of doctors who have been used to focusing on diastolic hypertension for the past 30 years. (The old dogma held that diastolic hypertension was far more important than systolic hypertension. The new dogma is almost exactly opposite.) Quite simply, doctors may simply need some time (though they've already had a couple of years) for the new reality to sink in.
In the meantime, if you are a patient whose systolic blood pressure is consistently above 140, you should not wait for your doctor's consciousness to be raised. The new studies are pretty convincing - systolic blood pressures of 140 or higher seem to appreciably increase the risk of cardiovascular disease. You should press your doctor to help you get your blood pressure down into the safe range.
