If you live long enough, you'll probably get hypertension. That's despite the fact that it's a relatively easy condition to prevent, simple to diagnose and inexpensive to treat. And that has the Institute of Medicine in a state of consternation.
Hypertension, or high blood pressure, is a leading cause of disease in the United States. As a killer, it's second only to tobacco. Yet it's basically a neglected disease, says Dr. David Fleming, head of the IOM committee behind a new report on hypertension and the King County public health director in Seattle.
"Hypertension is in a no-man's land, somewhere between public health and the medical community, but neither community has full control of the problem," he says.
Most people have picked up on the public health message: You can keep blood pressure under control by losing weight, exercising more, cutting back on salt, and not smoking. For its part, the medical community has assumed responsibility for treating the consequences of out-of-control hypertension, such as strokes and heart disease.
The IOM, however, wants to know why physicians aren't following guidelines on prevention or treatment of hypertension before it lands a person in the ER. The IOM says the vast majority of patients with hypertension — 86 percent — have insurance and see a doctor regularly, yet physicians aren't following clinical guidelines.
To their credit, doctors have been very aggressive — and very successful — at controlling diastolic blood pressure, the bottom number in a blood pressure reading. Normal blood pressure is between 120/80 and 139/89.
But that focus may be part of the problem, says Dr. Corrine Husten, an IOM hypertension committee member.
For people over 50, it's the top number — systolic blood pressure — that's actually more important. That number shouldn't get over 140, yet doctors aren't treating systolic blood pressure that aggressively.
"As the pressure gets higher, it begins to damage the walls of the blood vessels," Seattle's Dr. Fleming says. "Heart disease, heart attacks (and) strokes result from damage to the blood vessels so that blood can no longer flow through to key organs, including the brain and the kidney."
So the IOM committee is calling on the CDC to investigate why physicians aren't adhering to treatment guidelines more closely.
And if you're looking to point a finger on another reason behind hypertension's pervasiveness in American culture, it's salt. What most of us forget as we reach for the shaker is that salt is already in many of the foods we buy and restaurant meals.
Maybe this might help you remember: A spoonful of sugar may make the medicine go down, but any more than a spoonful of salt day is overload. If you're over 65, make that a third of a spoonful.