Hypertension is something to stress over

Hypertension really is something to stress over.
An estimated 50 million Americans have high blood pressure. Only about half of all adults have blood-pressure readings at or below 120 over 80 (beating heart and resting heart) -- the cautionary threshold for pre-hypertension.
Yet research shows that nearly a third of people with hypertension don't know they have the condition and only about 60 percent of those who do know get treatment.
To be sure, the medical community has several times lowered the standard for hypertension and established the yellow-flag zone of pre-hypertension only in the last few years -- moves that some critics claim have been driven by pharmaceutical interests.
But the surge in high blood pressure likely has at least as much to do with Americans' collective weight gain, dubious diet and stressful lifestyle.
Researchers are only beginning to understand how the body regulates blood pressure normally, what role genes, obesity, stress and other factors play. The mechanisms appear to be different between men and women, and the risks change as we age. The older you are, the more likely you are to have high blood pressure. But there are variables, even in old age.
For instance, in a report published this week in the Archives of Internal Medicine, French researchers found that elderly people are more prone to high blood pressure during cold weather.
The average beating-heart blood-pressure reading was 5 millimeters of mercury higher in measurements taken during the winter versus summer. And nearly 10 percent more of the more than 8,800 French participants in the study had high blood pressure during the winter.
The researchers suggest pressure spikes because the involuntary nervous system ramps up when it's cold, boosting the heart rate and reducing the responsiveness of blood vessels.
Another study, published last month by psychologists at North Carolina State University, found that older adults who already had average beating-heart blood pressure of 130 or higher experienced a significant decrease in the ability to think clearly when their blood pressure spikes. That suggests that seniors with high blood pressure may find it especially difficult to think clearly in stressful situations.
Of course, spikes in blood pressure aren't confined to the elderly.
Several recent studies have tied being exposed to polluted air to increases in blood pressure among people of all ages.
And a study published last summer in the International Journal of Psychophysiology found that people who are fatigued experience greater blood-pressure surges when they attempt to complete a difficult task than do people who are well-rested.
One of the biggest problems in identifying and treating people with high blood pressure is that most people with hypertension don't have any symptoms. This allows the disease to silently damage organs for years.
And because taking medications to reduce blood pressure doesn't make most patients feel better, they're more likely to skip doses or not fill a prescription at all than someone taking medicine for an acute illness that causes pain or limits function.
A major reason that people don't discover they have high blood pressure -- and often don't manage it well if it is detected -- is simply that doctors don't check it regularly.
A study published last May in the journal Hypertension analyzed care given during visits to private physicians' offices during 2003-04, based on data collected by a federal survey.
It found that blood pressure was measured in only 56 percent of all patient visits, although BP was checked in 93 percent of visits by patients who had already been diagnosed with hypertension.
"Many physicians in specialized practice appear to feel they don't need to measure blood pressure,'' said Dr. Randall Stafford, co-author of the study and an associate professor of medicine at Stanford University School of Medicine. "The thinking goes, `I'm a dermatologist, so I don't need to screen for high blood pressure.' But because there's a high likelihood of high blood pressure being missed, we need to take advantage of all opportunities for screening."
The researchers also noted that a failure to prescribe appropriate medications and to educate patients on the need to stick with medications, along with inconsistent patient monitoring, largely explains why only about a third of those diagnosed with hypertension are reaching treatment goals.

On the Net:
www.ahajournals.org
archinte.ama-assn.org

(E-mail Lee Bowman at bowmanl(at)shns.com. Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
THE MEDICAL JOURNAL