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Safe Blood Pressure Readings - Have Doctors Been Wrong for 100 Years?

QUESTION: Hello Dr. Costrini. My name is Michael. I am 31 years old. I live in Savannah, and our family has been discussing high blood pressure lately because my father has had high blood pressure for years and has now developed a stroke. I do not have high blood pressure, but my brother and sister do. What advice can you offer for the prevention of problems like my father has had to deal with?

ANSWER: Michael, your question goes to the very heart of how we can actually improve the health of Americans in the coming decades. Cardiovascular disease is the number one cause of death with over 750,000 deaths annually due to heart disease, stroke and related cardiovascular diseases. High blood pressure and smoking are leading predictors of cardiovascular complications. As we seek to improve health care, prevention of the risk factors is an important consideration. At the present time, if an individual has a blood pressure of 135/80, he is pronounced to have normal blood pressure and hopefully at low risk for a heart attack or stroke. However, if one asks the question, Am I at risk for developing hypertension in the future," the issue becomes more important for you as an individual and very much more important for the health of our society in the coming decades.. The lowest-risk blood pressure is probably 110/75 with the systolic (the upper number) being in the 110 range and the diastolic (the lower number) being in the 75 range. Some very valuable lessons have come from following patients over time who begin with normal blood pressure. This has been done in the Framingham Heart Study. What has been found is that we can predict the likelihood of developing high blood pressure by following certain risk factors. For instance, age is certainly a risk factor for the development of high blood pressure ( i.e. stiffening of the vessels). Males and females are probably equally likely to develop high blood pressure at some time in their lives. Clearly, if you are overweight, the risk of developing high blood pressure within as little as four years is significantly affected. Additionally, high blood pressure has an inherited component and the presence of high blood pressure in one or both parents increases the risk of offspring high blood pressure. Finally, cigarette smoking certainly contributes to the development of high blood pressure. The cigarette smoking issue is somewhat problematic in that smoking may increase blood pressure, but if one stops smoking and body weight goes up significantly, there is the likelihood of developing high blood pressure on the basis of the risk factor of obesity. Hence, as we all have come to understand, for prevention of heart disease it is important that a smoking cessation program be conducted in conjunction with a weight control program. The risks of developing high blood pressure in 4 years rises from about a 10% risk if there are no significant risk factors present to as much as 25% if perhaps the lower number of the blood pressure is even up to only 85 mmHg. Hence, the blood pressure of 140/85 in a 45-year-old male actually significantly increases the risk of high blood pressure within the next 4 years by about threefold. Additionally, if an individual has a blood pressure of 140/80 and is overweight, the likelihood of developing high blood pressure rises from approximately 25% to 50% in the subsequent 4 years. From this, it is clear that the contribution of being overweight to the subsequent development of high blood pressure cannot be overstated. The important point about high blood pressure risk is that high blood pressure shortens life expectancy and that high blood pressure precedes heart attack, stroke and heart failure by a long interval. Prevention of hypertension either by lifestyle changes or by medications in individuals who are at high risk would seem to be a very logical step. For instance, in your case, your blood pressure may be normal. However, if your are overweight, and one of your parents had high blood pressure and if your current blood pressure is 140/80, then you have a substantial and significant risk of developing high blood pressure in the future. The essential thing you can do in your personal situation is to reduce your body weight and begin an exercise program. Your normal blood pressure alone is a risk factor for developing high blood pressure in the future. An ideal blood pressure with no risk contribution of developing high blood pressure is about 110 to 120 for the higher number and 70 to 74 for the lower number. Stated in other way, if your systolic blood pressure is 135 and the diastolic is 85, these numbers may be interpreted as normal blood pressure, but in fact they contribute to risk factors for the development of high blood pressure within 4 years. In summary, your blood pressure may be normal, but I would strongly suggest that you define the specific number of your blood pressure. If it is 110/ 70, the chances of your developing high blood pressure in the future are not increased. If, however, your blood pressure is 139/85, then indeed there is a substantial and probably nearly threefold increase in the potential of your developing high blood pressure within 4 years and this is further increased because of your family history and if your are somewhat overweight. At the present time, the state of American healthcare is characterized as one of too little, too late intervention. That is why the mortality rate is over 750,000 individuals per year. Appropriate prevention of cardiovascular disease requires reducing risk factors. While it is clear that one can control ones body weight and control the potential of smoking as risk factors, the fact that we now identify blood pressure ranges that are normal, but that can contribute significantly to the risk of developing high blood pressure in the future is an important observation. Addressing blood pressures in the high-normal range particularly by dietary modification and lifestyle changes is the appropriate response. At times, the use of medication to reduce blood pressure down to a safe-normal range has been shown to have benefit in preventing late development of high blood pressure. However, given the cost of medications for treating patients with normal, but at-risk blood pressure levels, we, as a nation, are not ready to embrace that concept. In closing, I think controlling your blood pressure to a safe-normal level, reducing your body weight to normal, avoidance of alcohol and engaging in an exercise program are reasonable approach to the modifiable risk factors for hypertension and subsequently heart disease. Some experts when discussing risk factors for heart disease and stroke make the mindless comment that one cannot control the age associated risk factor, i.e. we all get old. However, if the truly normal blood pressure of 110/70 were the goal of all care, the hardening of the arteries that occurs with age may not even take place and certainly most heart attacks and strokes would almost never occur. Most people who live to be one hundred years old have such truly normal, low risk blood pressure readings. From the Framingham Study, the data is compelling that doctors, society, and healthcare insurers have allowed two generations to live (and die) with blood pressures that are neither normal nor safe and indeed predict hypertension and all its consequences. Reducing blood pressure from the normal levels that predict pathology to the truly life and health sustaining lower levels is what you and your family should seek. Only by doing the same as a society can we all hope to prevent what your father has had to endure.

Dr. Nicholas Costrini writes regularly for the Savannah Morning News. His articles occur every other week in the close-up section. He may be contacted at ncostrini@georgiagi.com.

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