Like its predecessors, this latest report (called "JNC-7" for short) has already become the gold standard for hypertension management. Consequently, now may be a good time to look critically at some common perceptions about blood pressure. Check your hypertension "IQ" by classifying the following statements as either true or false:

Blood pressure over 140/90 is often normal in older people and may not require treatment.
False. Current guidelines make no distinctions by age. The JNC-7 report recognizes three categories of hypertension. Persistent readings between 120/80 and 139/89 constitute a new category called prehypertension, for which lifestyle modification is encouraged. Blood pressure between 140/90 and 159/99 is called Stage 1 hypertension, usually requiring both lifestyle modification and drug treatment. Blood pressure of 160/100 or higher is called Stage 2 hypertension and usually requires two or more drugs to control.

Even though high blood pressure is common, most people grow old without developing it.
False again. Among people aged 55 with normal blood pressure, the lifetime risk for developing hypertension is 90%. That means almost everyone who lives to an advanced age will develop hypertension. How can a condition shared by almost all elderly individuals be called a disorder? Because it is a leading cause of heart failure, stroke, heart attack and kidney disease. In fact, the risk for these complications begins to increase when blood pressure rises above levels as low as 115/75.

The systolic blood pressure (the pressure in the arteries during a heart beat) is less important than the diastolic blood pressure (the pressure between beats).
This one is false too. Above age 50, elevated systolic blood pressure is commoner and much more damaging to one's arteries and heart than elevated diastolic blood pressure. There is nothing really new about this fact, but for some reason many people still harbor the misconception that the diastolic reading is the main culprit.

Most people with hypertension are being treated successfully.
Sadly, this is also false. According to JNC-7, only 59% of people with high blood pressure are even on treatment. Just 34% are under control. For hypertension to be considered under control, readings should average less than 140/90. For those with diabetes or kidney disease, the target for control is less than 130/80.

The benefits of effective blood pressure control are enormous. Marked reductions in the occurrence of heart and blood vessel disease are achievable. The risk of heart failure alone can be cut in half.

The side effects of blood pressure drugs are often more harmful than high blood pressure itself.
This statement might have defensible decades ago, but no longer. Doctors have better drug treatment choices than ever before. A safe, well-tolerated and effective regimen can be found for just about anybody. Nowadays someone with high blood pressure who declines drug treatment due to a fear of side effects is simply taking needless chances. And, this is no place for unproven herbal remedies.

The most important lifestyle modification for lowering blood pressure is to reduce stress.
Sorry, but this isn't true either. There's nothing wrong with stress reduction, but too many people emphasize this factor to the exclusion of other critical lifestyle measures. The JNC-7 report advises those with established hypertension or prehypertension to maintain (or strive for) a normal body weight, get regular exercise, limit dietary salt, moderate their alcohol intake and adopt a DASH diet.

"DASH" stands for "Dietary Approaches to Stop Hypertension". A DASH eating plan emphasizes fruits, vegetables and low-fat dairy foods. Whole grains, fish, poultry and nuts are encouraged. Red meat, foods rich in cholesterol or saturated fats, sweets and sugared beverages are discouraged. Just following a DASH diet can reduce systolic blood pressure by 8-14 mmHg.

In a busy doctor's office, it is easiest to measure blood pressure through a shirt or jacket while seated on the exam table.
True, it is the easiest way. It's just not the correct way. Blood pressure should be measured with the arm supported passively at heart level after being seated in a chair for five minutes. If one holds one's arm out actively, or if measurement is attempted through clothing, accuracy suffers.

Many authorities recommend self-monitoring of blood pressure with a home device, especially for those with a tendency to exhibit high readings only in the doctor's office. It's a good idea to discuss this with one's doctor and bring the device to office visits so that it can be checked for accuracy.

Where to get additional information:
The National Heart, Lung and Blood Institute (NHLBI) produced the JNC-7 report. The NHLBI is among the best comprehensive resources for information on high blood pressure. They can be reached by phone at (301) 592-8573 or on the web by going to http://www.nhlbi.nih.gov.

July 2003