This SARS stuff is really scary. No day passes without a piece on NPR, an article or two in the newspaper, a mention on the nightly news. Close to 800 people have died of the disease in China, the country hardest hit by SARS. Of course, some 1.3 billion people live in China, making the death rate something like one per 1.6 million people.
Compare this to an American statistic: 878,421 people died of cardiovascular disease (CVD) and stroke in 2000. That's one CVD death for every 313 Americans. Or how about this one? Ninety percent of 55-year-olds with a normal blood pressure will develop high blood pressure (hypertension) in their lifetime. That's right. Ninety percent. Risk is a funny thing, and our perception of it even funnier. Why aren't we in a panic about hypertension?
You'd think with odds that high, we'd all be getting our blood pressure checked on a monthly basis and our doctors would be all over us to start treatment ASAP. But one of the reasons that the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure decided to release a seventh report (the sixth was issued in 1997) this month was its feeling that the committee's previous report was not being used to its full benefit. In other words, recommendations from the last report have not impacted the behavior of physicians and patients as much as hoped.
Need a reminder about why we care? Well, first of all, 50 million Americans have high blood pressure. That's one out of every five of us. And we're worried about SARS? Hypertension is an independent risk factor for cardiovascular "events." The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke and kidney disease. Research cited by the JNC shows that in adults over 50, a systolic blood pressure (the top number) of greater than 140 is a much more important cardiovascular disease risk factor than the lower number. The goal, then, is to keep that number below 140.
The trouble with high blood pressure is that it is a disease without symptoms, until the damage it inflicts has been done. And then it really is too late. But according to the JNC, identification of "pre hypertension," blood pressures of 120-139/80-89, can be critical in short circuiting the path to America's major killer. If the climb to high blood pressure is arrested with lifestyle modification, and drug treatment if necessary, then we can make a real impact.
So obviously, the first thing to do is get your blood pressure checked often. Take advantage of free screening programs. Visit your health care provider regularly.
If your blood pressure is high, start changing things as the JNC recommends. Work on your weight, aiming for a body mass index (BMI) less than 25. (Adopt a sensible eating plan high in fruits, vegetables, and low-fat dairy products, and low in salt and saturated fat. A regular exercise program, with 30 minutes of aerobic exercise most days of the week, will help with the weight loss as well as lower blood pressure. Alcohol in moderation only (no more than two drinks a day), and of course, quit smoking.
If lifestyle changes don't work, the JNC recommends drug therapy. There are some really sophisticated drugs out there - beta- blockers, angiotensin converting enzyme inhibitors, calcium channel blockers and angiotensin receptor blockers, all relatively new and all pretty expensive. But in what must surely be a case of divine intervention when it comes to such a widespread disease, the best drug to start with is the one we used when I was in training - the diuretic hydrochlorthiazide - and a low (cheap) dose of it at that.
The hard part may be to take a pill every day when you feel fine. But we're playing the odds here, and they are not in our favor. Not even close.
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