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High blood pressure up { July 9 2003 }

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High Blood Pressure's Prevalence Up, Study Finds

By Rob Stein
Washington Post Staff Writer
Wednesday, July 9, 2003; Page A01

High blood pressure is on the rise again in the United States, reversing a decades-long downward trend for a major cause of heart attacks and strokes, researchers say in a report released today.

Although the researchers did not examine why the prevalence of high blood pressure is increasing, the jump coincides with a sharp rise in the number of Americans who are overweight or obese, a major cause of hypertension.

"We think that's probably playing a role in this increase," said Ihab Hajjar of the University of South Carolina, one of the authors of the new study, in a telephone interview.

Nearly a third of U.S. adults have hypertension, according to the latest statistics from a large, ongoing government survey. This represents a rise of almost 4 percent from a decade earlier. It is the first documented overall increase since the 1960s.

"This should be a wake up call to the American public," said Daniel Jones, dean of the University of Mississippi Medical School and a spokesman for the American Heart Association. "Unless something is done about this, this is going to lead to an increase in heart attack and stroke in the future. This will translate in later years to more heart disease and heart disease deaths."

Heart disease and stroke are the nation's No. 1 and No. 3 killers, respectively.

"This important paper is another reminder we need to get on the ball about blood pressure," said Edward Roccella, coordinator of the National Health, Lung and Blood Institute's National Blood Pressure Education Program.

Roccella noted that high blood pressure can be avoided and lowered by losing weight, eating a more healthful diet and exercising, and by taking drugs if that regimen does not work.

"If you don't find time for exercise, you will find time for illness," Roccella said.

For the study, Hajjar and Theodore A. Kotchen of the Medical College of Wisconsin analyzed data collected from a nationally representative sample of 5,448 adults age 18 and older in 1999 and 2000 as part of the National Health and Nutrition Examination Survey. The survey is conducted regularly by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention in Atlanta.

"There's been a lot of very favorable trends in hypertension over the last 30 years," Hajjar said. "However, there have been some preliminary reports that these favorable trends are actually plateauing. We wanted to look at these trends."

The researchers found that 28.7 percent of those surveyed had high blood pressure -- defined as 140 over 90 or above -- an increase of 3.7 percent from 1988-1991, the previous time the survey was conducted. That translates into about 58.4 million Americans who are suffering from hypertension, which produces no symptoms but is easily detected by testing with the familiar blood pressure cuff.

Although blood pressure above 140 over 90 is considered high, officials say a level below 120 over 80 is desirable. Blood pressure between 120 over 80 and 139 over 89 is considered "prehypertension," which means a person is at risk for high blood pressure.

The rate was highest -- 33.5 percent -- among non-Hispanic blacks, the researchers report in today's issue of the Journal of the American Medical Association. Women were found to be more likely than men to have high blood pressure -- 30.1 percent vs. 27.1 percent. Jones attributed this to the fact that women are more likely to be overweight earlier in life, although they also tend to be protected against the adverse effects until menopause.

High blood pressure is most common among those 60 and older -- afflicting 65.4 percent of those in the survey. The aging of the population could explain some of the increased prevalence, but the rate was up overall even when that was taken into account, Hajjar said.

"I think this should draw attention to this problem," Hajjar said. "We need to be very vigilant about making sure we get blood pressure checked and make sure people get blood pressure treated if it's high."

In fact, the proportion of people in the survey who had high blood pressure and who were aware that they had a problem decreased -- falling to 68.9 percent, a 0.3 percent drop.

However, the proportion of people with high blood pressure who were getting treated increased to 58.4 percent -- a 6 percent jump. And 31 percent of those being treated were able to get their blood pressure under control, an increase of 6.4 percent.

"The good news in this report is the hypertension control rates are substantially better than they've been in the past," Dean said. "That is really good news. Both patients and health care providers are taking the treatment of hypertension seriously."

But women, Mexican Americans and those 60 and older were found to be significantly less likely to control their blood pressure than men, younger people and non-Hispanic whites.

"Anytime you see numbers like this, it's concerning," Roccella said.

2003 The Washington Post Company

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