U.S. Lowers 'Normal' Levels for Blood Pressure Readings *
By THE ASSOCIATED PRESS

WASHINGTON — The government said today that millions of people who
think they have healthy blood pressure do not.

In a major change, new federal guidelines say levels once considered normal or borderline actually signal "prehypertension," and those people must take care to stave off full-blown high blood pressure, called the silent killer because it often exhibits no symptoms until damage is done.

High blood pressure measures 140 over 90 or more — and that level has
not changed. But until now, optimal blood pressure was considered 120 over 80 or lower; normal was up to 130 over 85; and levels above that were called borderline until patients reached the hypertension range. But the new guidelines classify normal blood pressure as below 120 over 80 — and readings anywhere from 120 over 80 up to 140 over 90 as prehypertensive — affecting about 45 million Americans, researchers said.

Blood pressure is measured as two values, with the first, or top, number in the reading called the systolic reading (as the heart beats), and the second, or bottom, number called the diastolic reading (as the heart rests between beats).

Recent studies show that risk of heart disease actually begins rising once blood pressure creeps above 115 over 75, said guideline co- author Ed Roccella, a hypertension specialist at the National Heart, Lung and Blood Institute, which issued the new recommendations. There is a doubling of risk for each 20-point rise in the first or top number of the blood pressure reading or 10-point rise in the second or bottom number.

Dr. Aram Chobanian, dean of the Boston University school of medicine and chairman of committee that wrote the guidelines, said: "We don't want to frighten the public, we want to get action. Even small changes in blood pressure are important."

Also in the guidelines:
Most people who already have high blood pressure will need at least two medications to control the dangerous disorder. For the majority of patients, one of those drugs should be a cheap, old-fashioned diuretic. The most important number for anyone over age 50 is the systolic, or top, number, something that researchers say too few doctors and patients understand. If nothing else, that number should be below 140; the bottom number should be no higher than 90. The guidelines urge doctors to be far more aggressive in treating hypertension, noting that almost one-third of people with high blood pressure do not even know it. Plus, two-thirds of diagnosed patients do not have the disease under control — too often because doctors hesitate to prescribe a second or third medication, according to a co-author of the guidelines, Dr. Daniel W. Jones of the American Heart Association.

An estimated 50 million Americans have high blood pressure, raising their risk of heart attacks, strokes, heart failure, kidney damage, blindness and dementia. "We hope it's going to catch people's attention," Jones said of the new prehypertension category. "They are at higher risk for going on to develop hypertension and they need to take action." That does not necessarily mean medication. People with prehypertension should lose weight if they are overweight, get regular physical activity, avoid a salty diet and consume no more than two alcoholic drinks a day. All those factors increase blood pressure, the guidelines say. "Most of us will have hypertension if we live long enough," Roccella said. The hope is that if people know they're prehypertensive — even if they're a skinny 20-something with 120 over 80 readings today — they'll make wiser lifestyle choices and thus stave off the blood- pressure creep that comes with age.

The guidelines will be published in next week's Journal of the American Medical Association, but because of their importance were released early online Wednesday.

*NYTimes.com/Health. 5/14/2003

On the Net:
JAMA
Federal hypertension info