One out of four people don't know they have hypertension

High blood pressure is a major risk factor for heart attack, stroke, and renal failure, but one out of four people don't even know they have it.

If you're over 60, there's a good chance that you have hypertension. High blood pressure affects at least 65 million Americans, rarely presents any symptoms, and, if left untreated, can have fatal consequences, according to UCLA's Healthy Years.

Results from the National Health and Nutrition Examination Survey (NHANES), conducted by the Centers for Disease Control and Prevention and published in a recent issue of the American Heart Association's (AHA) journal Hypertension, revealed that in 2003–2004, only 37 percent of people with hypertension were successfully keeping their blood pressure under control.

Hypertension was reported as the primary or contributing cause of death in more than a quarter-million Americans in 2002. “The biggest danger from uncontrolled hypertension is, of course, the risk of a brain hemorrhage (hemorrhagic stroke and lacunar stroke),” says Arun Karlamangla, MD, assistant professor of medicine in the Division of Geriatrics at UCLA. “Blood pressure does not have to be high for long periods of time for these events to happen.

“Other risks are of blood clots forming in the coronary arteries (a heart attack) or arteries to the brain (ischemic stroke). If blood pressure is high for years, it can also lead to increased atherosclerotic plaques in these same arteries and the arteries of the legs, which then become substrates for clot formation.”

According to the AHA, even a small reduction in high blood pressure—especially in people over 60—can help decrease the incidence of strokes and heart attacks. The recent study showed an improvement in the percentage of people with controlled blood pressure, particularly those over 60, compared to a similar study conducted in 1999–2000; the AHA attributes this improvement to public education and a better awareness of the condition and recommended treatments.

Prevention. To avoid the potentially life-threatening consequences of uncontrolled hypertension, the most important thing you can do is have your blood pressure checked regularly, and work with your doctor to keep it under control.

“While genetic factors may account for as much as 30 percent of the blood pressure increase seen in the population, a number of environmental factors have a definite role in causing high blood pressure,” says James Davis, MD, a professor of medicine at UCLA. “Increased salt intake, excessive alcohol intake, and obesity are modifiable risk factors for the development of high blood pressure. Reducing salt and alcohol intake, and reducing weight through a combination of dietary modification and exercise can both prevent hypertension and reduce blood pressure in those already afflicted. Atherosclerosis is also linked to hypertension, and aggressive identification and treatment of patients at risk will reduce hypertension as well.”

Treatment. For some patients, it may be difficult to keep blood pressure at a safe level without the help of medication. There are many different kinds of medication to treat high blood pressure; your doctor can customize a treatment regimen that works best for you (see sidebar).

“While most patients will benefit from the use of a low-dose diuretic such as hydrochlorothiazide, the choice of medications needs to be tailored to the individual, and often depends on whether or not the person has comorbid conditions,” says Dr. Davis. “People who have diabetes or heart disease in addition to high blood pressure will benefit more from certain types of medication than from others. Patients can optimize blood pressure control by working closely with their physician and other caregivers.”

Even without any symptoms, you could be at serious risk for some very dangerous complications. “High blood pressure is asymptomatic, and that is why screening for hypertension is so important. Periodic health examinations beginning early in life and continuing into old age are the best way to identify patients with hypertension,” Dr. Davis states. “Health fairs and community-based screening programs also can lead to early identification of the condition. Those who have relatives or family members with hypertension or have a family history of stroke or heart disease should be especially concerned about having their blood pressure checked.”

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