Blood Pressure Specialist Montgomery Village MD

Blood Pressure Concerns

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By James Keough

Not so long ago, you either had high blood pressure or you didn’t. Your blood pressure could even flirt with the high normal range without anyone getting overly worked up about it. The same held true for elevated-but-still-normal blood sugar levels. But all that changed over a 10-year period as the medical profession established new benchmarks and reclassified the old “normal” as “preconditions.”

For blood pressure, that happened in 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) set guidelines for pre-hypertension by defining normal blood pressure as less than 120/80 and setting the optimal level at 115/75. That same year, the term pre-diabetes gained new meaning and considerable traction when then-Health Secretary Tommy Thompson used it to warn Americans of their high risk of developing diabetes. Ten years earlier a committee hosted by the World Health Organization had established bone mineral density readings as the new measure for osteoporosis and at the same time created a new precursor called osteopenia.

At first blush, the concept of preconditions makes perfect sense. If you have a disease like diabetes, then ipso facto, at some point prior to your diagnosis your blood sugar levels became pre-diabetic—not in the sense of “before” diabetes, but rather as in “leading up to” the disease. And theoretically, once you learned that, you and your doctor could take action to make those levels normal again and thus prevent the onset of the disease. And in an ideal—and perhaps less complicated—world that’s what would happen.

The value of a precondition
When asked about the value of reclassifying “high-normal blood pressure” as pre-hypertension, a doctor joked that previously the only thing his patients heard when he used the old term was “Hi, your blood pressure is normal.” For him—and for a good deal of the medical profession—the new precondition underscores the seriousness of the situation for patients. How bad is it? Studies show that compared to people who have normal blood pressure, those with pre-hypertension (120/80 to 139/89) have three and a half times the risk of heart attack and more than one and a half times the risk of coronary artery disease. Other studies have shown that starting at the new optimal level (115/75), the risk of heart attack doubles with each 20-point increase in systolic blood pressure (the top number) or 10-point increase in diastolic blood pressure (the bottom number). Pre-hypertensives also face a vastly increased risk of developing high blood pressure. The Framingham Heart Study found that within four years of baseline testing, 39 to 53 percent of people with high-normal blood pressure (the top half of the current pre-hypertension range) progressed to stage 1 hypertension.

These are not good odds—and they get worse the older you are when first diagnosed with pre-hypertension and the longer you ...

Author: James Keough

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