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Rising stroke deaths sound alarm on hypertension

Concerned by rising deaths from stroke, a government panel Thursday called for aggressive new measures to detect and treat high blood pressure.

Nearly 75 percent of the 50-million Americans with elevated blood pressure are not properly treated for the condition and thus face significantly increased risk for heart and kidney disease and strokes, according to the National Heart Lung and Blood Institute, which issued the report.

What worries public health officials is a small but persistent increase in stroke deaths and a leveling off of mortality from heart disease during the past four years. These changes follow two decades of consistent decline in deaths, when stroke mortality dropped 60 percent and deaths from heart disease fell 53 percent, according to the National Center for Health Statistics.

Congestive heart failure and end-stage kidney disease are also rising across all age groups in the United States. Both are direct complications of poorly controlled high blood pressure, known as hypertension.

Blood pressure is the force generated by the blood on the arteries as the heart pumps blood throughout the body. Systolic pressure occurs when the heart contracts. Diastolic pressure is the amount of pressure in the arteries when the heart is at rest.

The new guidelines update recommendations last issued in 1993.

Optimal blood pressure levels are still defined as 120/80 in the new guidelines. "High normal" blood pressure, ranges from 130 to 139 over 85 to 89. High blood pressure is defined as anything above 140/90.

The new guidelines urge aggressive treatment of people with even "high normal" levels of blood pressure, especially if they also have other medical conditions, such as diabetes, kidney disease and high levels of blood cholesterol.

For the first time, the guidelines also provide clear recommendations about which drugs should be used to treat which patients, a move that many doctors said they welcomed.

No matter how severe the elevated blood pressure, the guidelines say that hypertensive treatment should include changes in lifestyle. Among these are weight loss, daily exercise such as a brisk 30- to 45-minute walk and smoking cessation.

For the first time, the recommendations also include ways to control blood pressure using diet, including limited alcohol and salt intake, an approach that was shown to be particularly effective in people with early stage hypertension and no other medical conditions.

These people should use diet, exercise and weight loss for at least a year _ about twice as long as the previous recommendations _ before turning to medications, the guidelines said.

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