The Ugly Truth About Hypertension

For years now, therapy for high cholesterol has been a cheap thrill. You can get your cholesterol measured almost anywhere, and it is easy to bring down. Sure, you almost always get subjected to a lecture about lower-fat diets (yada, yada, yada…), but, in the end, most people get a pill. And the pill of choice has virtually always been a statin — miracle drugs that are virtually free of side effects, and magically produce 25 percent, 35 percent or even greater reductions in cholesterol levels.

Such quick, easy results are good news. Patients love getting good news, and doctors love giving it. And the fact is that cholesterol .is very important, and many lives have been lengthened because people are doing a better job lowering their levels with diet as well as pills.

If bringing down cholesterol is the cheap thrill, then controlling hypertension is the equivalent of having a root canal — every day. High blood pressure is an important, treatable cause of heart attack, heart failure, stroke, kidney disease, and blindness, and most people over age 60 have it. Nevertheless, relatively few people want to talk about it — even though it is more common than high cholesterol.

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The result is that we — doctors and patients — do not do very well in controlling hypertension, and, as the years go by, we are doing worse, not better. Epidemiological data show that fewer people with hypertension are taking their medications and controlling their blood pressure now than a decade ago.

Why is hypertension so tough to deal with? Here are a few of the most important reasons so many people would rather have a needle stuck in their arm to draw a cholesterol test than talk about their blood pressures:

  • Most people need more than one drug to control their blood pressures, and some of these pills need to be taken more than once a day.
  • The drugs themselves are more likely to cause side effects than statins. Some cause impotence for men (for example, beta-blockers and diuretics). The water pills make you run to the bathroom at inconvenient times. They all can make you light-headed.
  • The lifestyle “opportunities” to improve blood-pressure control are numerous, and all too challenging. Who wouldn’t feel numb after being told to lose weight, exercise more, reduce salt, add more fruit and vegetables and fiber, drink less alcohol and — oh, yes – relax!
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As bitter a medicine all this good advice may seem, the most painful information is only slowly sinking in — the real goal isn’t to get your blood pressure under 140/90 mm Hg. “Optimal” blood pressure is below 120/80 mm Hg.

According to guidelines from the National Heart, Lung, and Blood Institute, people who have systolic blood pressures (the top number) of 140 or more or diastolic pressures (the bottom number) of 90 or more have hypertension. But that doesn’t mean people with blood pressures of 138/88 mm Hg are off the hook. Systolic blood pressures of 130 to 139 or diastolic readings of 85 to 89 are now considered “high normal” — and people with high normal pressures have a high chance of developing clear-cut hypertension and its complications.

“Normal” pressures are systolic numbers under 130 and diastolic pressures below 85, but the most recent guidelines are explicit that getting pressure under 120/80 is the real ideal.

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Not many Americans middle aged or older have blood pressures under 120/80. For a generation of baby boomers that draws comfort from having the best, the news that their blood pressures are not optimal is upsetting. Information on what it would take to get them to optimal blood pressures is even more disturbing.

That said, the first step to solving any problem is to recognize it. People who are just delighted with their cholesterol levels need to take a good hard look at their blood pressures. If the numbers are about 130/85, they should recognize that they have a problem. The good news is that it is a solvable one, and although the fix isn’t cheap, it really pays off.

Thomas H. Lee, M.D., is the chief medical officer and the medical director for Partners Community HealthCare, Inc. He is an associate professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women’s Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.


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