Did you know that one in three American women have high blood pressure, which is another name for hypertension? It is a leading risk factor for heart disease, but one that can usually be controlled and sometimes even prevented.
In April 2009, Sister to Sister invited three of this country’s top blood pressure experts to participate in a roundtable discussion on hypertension: Ed Roccella, PhD, MPH; Henry Black, MD, MACP; and Nancy Houston Miller, RN, BSN. We listened in as they talked for one hour, colleague-to-colleague.
See what the experts say women in Sister to Sister’s online community need to know and do to have a healthy blood pressure…including you! Just click the links below.
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Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Are there any symptoms for high blood pressure that women should watch out for?
Ms. Houston Miller: High blood pressure is an asymptomatic condition, except in very rare situations like when extremely high blood pressure can cause headaches to occur. Because most people do not experience any symptoms, it’s important to get your blood pressure checked on a regular basis. That includes with every single visit to a physician or nurse practitioner, irrespective of why you are there.
Dr. Roccella: When you say to have your blood pressure measured, you mean having a doctor or nurse put a blood pressure cuff put on your arm?
Ms. Houston Miller: Exactly. That is the first step in the process. However, there is increasing evidence for people to recognize the benefits of home blood pressure monitoring not only for diagnosing hypertension, but also for looking at how well people are being treated for hypertension and for monitoring how well medications are lowering blood pressure. Today’s state-of-the-art home blood pressure monitors can also help detect white coat hypertension -- when blood pressure is elevated in the office but may not be elevated at home -- and also the reverse of that which is masked hypertension, in which blood pressure may be totally normal in an office setting but elevated at home.
Dr. Roccella: Do you recommend home blood pressure monitors to your patients?
Ms. Houston Miller: I certainly recommend them to all of my patients and I think that it is important for people to recognize that we are recommending oscillometric devices that are used for the arm, that have really gone through validity and reliability testing, so that we know of their accuracy. There are two websites people can visit to determine which monitors have passed the vigorous standards that are so necessary to ensure accuracy. One is the dabl Educational Trust and the other is the British Hypertension Society website.
Dr. Black: One thing I think is important for home monitoring is that we do it intelligently. I have colleagues who feel that every home should have a blood pressure monitor just the way they have a thermometer. I do not think that is quite the case because we use the thermometer when we think we are sick, and we do not want people to take their blood pressure just when they think they are sick. We want people to take their blood pressure routinely to keep an eye on it -- on a standard day, maybe a couple of times a week, maybe once a week, maybe even once a month. That is the way we are going to get the most important information.
Dr. Roccella: So is it fair to say that the two of you agree that working with your doctor and nurse clinician, monitoring your blood pressure at home, and bringing in your recordings to show them is a good way of keeping tabs on what is going on with your blood pressure?
Ms. Houston Miller: Yes. I think what is often missing for people is the physiologic feedback that they need to see in terms of what is actually happening to blood pressure when they go on new medicines or are trying to determine a diagnosis of high blood pressure. The only way to get that is to have multiple measures, and home blood pressure monitoring is much easier than having to constantly go to the doctor’s office.
Dr. Roccella: What should a woman do if she is, say, at the gynecologist’s office and has a high blood pressure reading? Should she go see a cardiologist? Should she tell her primary care physician?
Dr. Black: It can be any healthcare provider with whom she feels comfortable. One of the things we need to explain is that having an elevated reading when you are anticipating a gynecological exam or when you are in a traffic jam or other stressful situation isn’t the same as diagnosing hypertension. To properly diagnose hypertension, you need to take blood pressure three times in a quiet room and then you see what those numbers are.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Let me begin by asking some general questions. Henry, why is hypertension, or high blood pressure, so important? Can you explain what it is and how it impacts a woman's health, especially her heart health?
Dr. Black: Thanks for that question, Ed. Hypertension is what we call a risk factor. In my view it is not a disease, although some of my colleagues would disagree. It is a characteristic that we have -- like our height or our weight -- which is a problem because as blood pressure rises from levels that are definitely within the normal range, the likelihood of arterial damage and of major target organ damage in the kidney, in the brain, in the heart, and in the blood vessels goes up as well.
This is particularly a problem for older women and, in fact, it is the most ubiquitous risk factor for heart failure and also other consequences. We worry about elevated readings because we now have evidence that lowering blood pressure is beneficial, and preventing the cardiovascular epidemic requires that we intervene before the target organ damage occurs.
Dr. Roccella: Nancy, what's this "target organ damage" Henry just mentioned?
Ms. Houston Miller: I think the most important thing for women to realize is that high blood pressure causes major health problems, and "target organ damage" means it causes damage to more than one organ. So high blood pressure can certainly cause damage to the heart and may cause a stroke, but it can also cause conditions like kidney failure. Unfortunately, one in three women in this country today have high blood pressure and, as Dr. Black has just said, that number increases with age. Since women live longer than men, they may live longer with diseases that can be very, very difficult for them in terms of overall quality of life.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: You have both been involved in national policy issues and with major research studies. This is a loaded question, but what would you wish for in terms of hypertension prevention, control, or research issues that you would like to see this country deal with?
Ms. Houston Miller: I can tell you one thing that I would like to see from a population standpoint is that we were able to lower systolic blood pressure by somewhere between 2 mmHg and 5 mmHg in general. This means there would be public health approaches to this condition that would include everything from ensuring that kids at a young age have physical activity in school to addressing the high rate of overweight and obesity in this country. To really effect change, we'd have to work with the food and salt industry to lower sodium in the diet. This is a huge goal, but I think it is one that would really prevent so much of the disease burden that we are seeing.
Dr. Roccella: The High Blood Pressure Education Program is one of the largest public health education programs in this country, and it has reported some pretty remarkable results. As two of the program's architects, is it your view that the low hanging fruit has been picked and now the remaining part of preventing, treating, and controlling high blood pressure is going to be more difficult? Or will it be even easier with all the data and information that we now have?
Dr. Black: Well, in a credit to you and to the National Heart Lung and Blood Institute's 35-year campaign against high blood pressure, today people are aware of hypertension. This is reflected in our national stroke mortality data, which has dropped dramatically. This means fewer people are dying from strokes.
There is certainly more to do. The public needs to know that there are treatments of all sorts that work. We have to provide them with information, advice, and an understanding of how to do it.
Ms. Houston Miller: I agree that we have made huge strides, and the national surveys -- the national health and nutrition examination surveys -- show that over three, almost four decades, the awareness of high blood pressure has increased substantially, the treatment has increased, and we are certainly seeing better control for individuals who are receiving clinical care.
As Henry has said, I think we are equipped now with the tools to do an even better job. Groups like Sister to Sister, which put out this important information to the public, help us to continuously move in the right direction toward preventing and better controlling high blood pressure.
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Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Nancy, are there women who are at increased risk for hypertension?
Ms. Houston Miller: To be honest, when you look at the fact that one in three adult Americans is going to suffer high blood pressure, I think that we all have to ensure that we are doing everything possible to prevent it.
Unfortunately, the leading cause of death in all women is cardiovascular disease. At least one in five women are going to have heart disease; some people say one in three. Cardiovascular disease is much more prevalent than cancer, and high blood pressure is a major risk factor. I do not think there is anybody who should forget this in terms of overall risk.
That said, high blood pressure is much more prevalent in non-Hispanic African American women, and slightly more prevalent in Hispanic women. When African American women reach midlife, the rate of hypertension is about 52 percent. So African Americans develop it earlier, they seem to have a little bit worse hypertension, and so it becomes critically important that we really focus on the women who are at high risk.
Dr. Roccella: Could you tell us about hypertension running in families? If we have high blood pressure in families, does that mean something?
Dr. Black: If you picked your parents incorrectly, that is what you get. If we see someone whose two parents have hypertension or who has hypertension on both sides of the family, the likelihood that they will have hypertension is virtually certain. What that means operationally is that these are people who have to be told unequivocally, even when they are young, that they've got to monitor their blood pressure and watch the things that Nancy was talking about: diet, exercise, and lifestyle. Because while we can certainly slow the progression, we cannot necessarily abolish it or eliminate it
Now, if you have one hypertensive parent obviously your risk is higher as well. And if you have none, that does not necessarily mean you are out of the woods. So you still have to watch.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: How about managing hypertension in older women, or even men for that matter. I mean, why bother? Is there any evidence that managing blood pressure in, say, somebody at 75 or 80 will matter?
Dr. Black: We can now say yes. We couldn't have a couple of months or maybe a year or so ago, with the exception of those who had a high systolic as the upper number and a lower diastolic as the lower number. But we now have a trial called HYVET which looked at healthy 80-year-olds and treated them for about two years with a combination of a diuretic and an ACE inhibitor and compared the results to those who got a placebo. Those on active medicines had a dramatic drop in stroke and heart failure and even mortality with very little, if any, side effects of adverse consequences. So there is no longer any justification for ignoring an elevated blood pressure, regardless of someone's age.
Dr. Roccella: You said earlier that if you reach age 55, you have a 90 percent chance that you are going to have hypertension in your lifetime. Are you telling us that we are all going to be hypertensive?
Ms. Houston Miller: At least one in three of us will. I think that if we focused on lifestyle changes much earlier, then we could probably prevent a large part of not only the development of cardiovascular disease but also these other target organ problems that occur as a result of high blood pressure.
Dr. Black: We don't want to scare people, because the alternative to not getting to 85 or 95 is worse than getting there. We just have to be aware that this is going to be a problem as we age, and we have to be prepared to deal with it and it need not be difficult to deal with. We now know that people over the age of 80 -- and probably without any age limit -- can have their blood pressure and the risk of blood pressure complications reduced. That is good news.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: The two of you were involved in a guideline called the Joint National Committee Report awhile back, and in that report you talked about a concept called "prehypertension." What does that mean and why is that so important?
Dr. Black: Prehypertension was the term that we devised back in 2002 to try to call attention to patients, health care providers, and journalists, too, that people whose blood pressures were in the 120 to 139 systolic and 80 to 89 diastolic were not free of the risks due to an elevated blood pressure, even though we had never defined that range as being definitely hypertension.
We have a large amount of observational data -- that is, watching people over time -- which shows that the risk of having a high blood pressure begins at much lower levels than where the diagnosis of hypertension occurs.
I hear people question what right do we have to call these people prehypertensives. Well, it is our responsibility to call attention to the fact that these people are not free of risk. This is the group that should get an unambiguous recommendation to adopt appropriate lifestyle modification. They should never see a healthcare provider without getting their blood pressure checked. They should buy a reliable blood pressure monitor and check it at home to try to avoid ignoring inexorable rise in blood pressure over time. This was not something we did to advocate getting more pills; quite the contrary! This is something we did to call attention to the risks. And it turned out to be a very, very appropriate suggestion and one that has stuck.
Ms. Houston Miller: I would agree, Henry, that we were very wise in making that recommendation. We did it, as you say, to remind people with blood pressures that begin at 115/75 mmHg that it is important to make lifestyle modifications in order to prevent high blood pressure and to prevent cardiovascular disease.
As you see blood pressure rise, cardiovascular disease risk really increases, and it doubles when you see a 20 mmHg increase in systolic and 10 mmHg in diastolic blood pressure. So ensuring that the people really try to carry out lifestyle changes is critically important to prevent high blood pressure. And, unfortunately, in this country today if you are at the age of 55 you have about a 90 percent lifetime risk of developing high blood pressure. It does not have to be that way. If we were to focus on achieving an ideal weight, exercising, avoiding the high consumption of alcohol, and really reducing our sodium, we would be in much better shape.
Dr. Roccella: The two of you are saying that the risk of hypertension does not start at 140/90 mmHg?
Dr. Black: Yes, it starts at a much lower number than that. We started with observational data in from 1 million volunteers in 61 studies encompassing 12 million volunteer years. I am very deliberately not calling these citizens patients. The increase in risk from blood pressure began at 115/75 mmHg and rose steeply as blood pressure rose. These were levels of blood pressure that we never worried about before and we would pat ourselves on the back if we had a blood pressure that was less than 140 mm Hg for systolic and less than 90 mmHg for diastolic. This large data set changed our mind. And now I pay much more attention to those in the prehypertensive range, 120-139 mmHg for systolic and 80-89 mm Hg for diastolic. When we begin to see blood pressure rising, as it inevitably does with age and with increasing weight, this is the time to take action to avoid the problems that an elevated blood pressure can cause. In fact, we have known for many, many years that a lot of the complications that we associate with elevated blood pressures begin or occur at levels much lower than where we diagnose hypertension.
Dr. Roccella: Are the two of you are suggesting that lifestyle modification could prevent the rise of blood pressures if we started soon enough?
Dr. Black: There are societies -- though not very many today -- where hypertension doesn't exist, the so-called un- or under-aculturated societies. Members of these populations are extremely thin and active, eat a healthier diet than we do, and don't have the type of stresses that we have. Rising blood pressure seems to be almost an inevitability of our modern life, but we can certainly do things to minimize it if we pay attention.
Dr. Roccella: Are these lifestyle modifications good for anything else?
Dr. Black: Well, they are good for overall cardiovascular health! For some people, being active and exercising can lower blood pressure, and it does reduce cardiovascular risk. Following the DASH diet has been shown to change blood pressure and has a very good effect on lipids. Keeping the sodium down is really what we focus on with blood pressure. Also, learning how to cope with stress has a lot of value above and beyond what it does to blood pressure.
Dr. Roccella: So with this DASH diet that Nancy talked about earlier, you can actually look to reduce your risk from lipids and your elevated cholesterol, too?
Ms. Houston Miller: Absolutely. There have been studies that have shown you can lower lipids with the DASH diet. I think the important thing for people to realize is the overlap between dyslipidemia, or elevated cholesterol, and hypertension is about 40 percent. So if you really adopt the lifestyle behaviors we are talking about for hypertension, you can decrease your cholesterol levels. Plus, these are important lifestyle behaviors just for overall aging, especially the whole area of the diet. Maintaining normal body weight and physical activity really relates to independence in older age.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: With so many options available today, should the cost of medicines be a problem?
Ms. Houston Miller: Cost, in most cases, should not be a problem. Many of these blood pressure medications have been used for a number of years and have low-cost generic versions available. Still, let your health care provider know if cost is an issue because when prescribing drugs, we can choose drugs that are going to be less expensive.
Dr. Black: The worst thing to do would be to not tell your health care provider that you cannot afford what he or she has just written for you and then just simply not take it.
Ms. Houston Miller: Exactly.
Dr. Black: The conscientious health care provider is going to work around it. Right now, just about every class of drugs, with one or two exceptions, has a generic version. It is important to understand that when we set up a regimen to meet a goal it may be necessary to sometimes have two or three drugs, or even more, to get there...and that stroke and a heart attack and kidney disease are pretty expensive also.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Many people are being treated for a whole host of issues, not only blood pressure. So it is not uncommon for them to be taking a dozen or more prescription medications. What does a health care provider need to know in this particular situation?
Ms. Houston Miller: Even with electronic medical records nowadays, studies have shown that 50 percent of the time physicians, nurse practitioners and others incorrectly note what an individual is taking. One of the best things that people can do to avoid this situation is always keep an updated list of their medicines and share it during every visit with a physician or nurse practitioner. Even better, they can "brown bag" all of their medicine bottles and bring them to every office appointment.
Dr. Black: I completely agree. I always tell people, especially those who have multiple medicines, 'Don't trust the list; bring in what you are taking. We will update it, we will see if it is right, and we will happily work with it as you go along.'
Dr. Roccella: The two of you are suggesting that people put all of their medicines in a bag, bring them in to the doctor's office, and put them all up on the desk?
Dr. Black: That is right.
Ms. Houston Miller: Absolutely. It is the best way of knowing what an individual is taking.
Dr. Roccella: Can things that you buy over-the-counter interfere with your blood pressure medicines?
Dr. Black: Yes. Nutraceuticals, food additives, and other preparations do not go through the rigorous scrutiny that drugs which go through the FDA do, and they can have an effect on blood pressure and heart rate and have side effects. So they are to be dealt with as if they are drugs.
Dr. Roccella: They could actually interfere with your blood pressure medicines?
Dr. Black: Sometimes they can, yes.
Dr. Roccella: So we need to even bring those in to the doctor or nurse practitioner, too?
Dr. Black: Absolutely. I want to see everything you're taking.
Ms. Houston Miller: That means vitamins and all other supplements.
Dr. Roccella: Bring in everything you buy in the health food store or the grocery store?
Dr. Black: If you are putting a foreign substance in your mouth, bring it in. It does not matter whether it is St. John's Wort or a medicinal plant, whether it comes in a pill or other form. It is something that could be a problem and we should see it.
Dr. Roccella: Even if you don't need a prescription?
Dr. Black: Even if you don't need a prescription.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Many visitors to Sister to Sister's website are, of course, women and may have some questions about how blood pressure drugs might interfere with hormones. For example, should women who are taking contraceptives or those who are undergoing hormone replacement therapy be concerned?
Dr. Black: For the most part, blood pressure drugs have been carefully looked at and they don't interfere substantially with any major hormonal functions. However, there are a few exceptions. Some drugs increase calcium absorption, like diuretics. And there are drugs like spironolactone, which is another type of diuretic, that have some hormonal influences. Women who are thinking of getting pregnant or who are already pregnant should not use drugs like ACE inhibitors, or angiotensin receptor blockers.
Dr. Roccella: So Nancy, should women who are contemplating starting a family talk to their doctors if they are on the kinds of drugs Henry is talking about?
Ms. Houston Miller: I think it is important for physicians to know which medicines people are taking, and it's important to discuss the need for coming off those medicines if necessary during pregnancy.
Dr. Roccella: What kinds of side effects from blood pressure drugs do we usually see?
Dr. Black: We have a hierarchy of the drugs from the best tolerated down to the ones that are least tolerated, and I will try to focus on issues that I think are problems for women.
Drugs like angiotensin receptor blockers seem to be the best tolerated, and when we compare these to placebos it is very hard to see any difference in the complaints. Drugs that are called dihydropyridine calcium antagonists -- examples would be nifedipine and amlodipine and felodipine -- tend to cause edema, or swelling in the ankles. That is a particular problem for women. This is a dose-related issue that can be generally be dealt with by reducing the dose.
Drugs like diuretics can lower potassium, they can initiate gout in some people, and they can also cause some metabolic changes that can be an issue.
If you have diabetes, beta blockers and diuretics can make it hard to deal with. Alternatively, ACE inhibitors and angiotensin receptor blockers may actually improve the status of people with diabetes, especially with protein in the urine. And there are sympathetic blocking agents, which are drugs that work in the brain or the nervous system and can make you fatigued and tired, and so those are the things that some people have to deal with.
One of the things that I think is important, at least I've begun to realize it lately, is that a lot of the side effects we used to blame on drugs -- like nonspecific nausea, vomiting, fatigue -- we also see these problems in the study volunteers given placebo and so we attribute the problems to the placebo. And when we use very well-tolerated drugs like anagiotensin receptor blockers and ACE inhibitors, they may actually lower the rate of those side effects. So hypertension may not be asymptomatic after all. Some of the things that people used to tell us that we did not think were related to the condition, may well be.
Ms. Houston Miller: The other thing that I think is important for people to realize is that we are using some medicines that have side effects, such as diuretics, at much lower doses now than we did several years ago. If we can use these medicines at low doses and we combine them with others, we see fewer side effects.
Dr. Roccella: So you are telling me that patients shouldn't have to tolerate the side effects of blood pressure medication? That they should talk to their doctors about them and things can be done?
Dr. Black: They can conditionally be done. I think it is very important that the lines of communication be open; that you can say what's on your mind and your doctor or nurse is prepared to answer and work with you to find the best regimen. There are times, though, when you may have to tolerate some medication side effects because the consequences of not getting your blood pressure treated may be even more devastating.
Ms. Houston Miller: The other important thing along those lines is to make sure that, if at all possible, people don't just stop taking their medicines to avoid side effects. As Dr. Black has said, people need to have an open communication with their health care providers. Just knowing that we have somewhere between 100 and 150 regimens to consider, really increases the opportunity to get people on medicines that will control their blood pressure and without causing discomfort.
Dr. Roccella: What can you tell us about side effects like sexual dysfunction? We've seen studies that it is a barrier to controlling blood pressure because people stop taking medicines that are associated with this effect.
Dr. Black: I think the issue is much more out in the open than it was a decade ago, and one thing that is being appreciated is that ED, erectile dysfunction, and ED, endothelial dysfunction, go together. So a lot of the things that people used to blame their antihypertensives for are actually a function of their blood pressure and its effect on the tissues that line the arteries. We need to work hard to prevent that damage from happening early on, and appreciate that if you tell me that you do have problems with erectile dysfunction it can sometimes be reversible.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals
Dr. Roccella: Henry, you mentioned that there is evidence showing the benefits of treating hypertension. What kinds of evidence are you talking about?
Dr. Black: Well, we consider our major evidence to come from large, well-designed, usually controlled trials and we have dozens and dozens of these now, which have made the point clear: As we lower blood pressure, the rate of strokes, heart failure, heart attacks, and probably kidney disease and dementia as well -- although that is not as quite as clear -- goes down accordingly. So that is the rationale for treatment.
Dr. Roccella: So you are telling us that there are studies which show that by treating hypertension, you can actually prevent strokes and heart attacks, and possibly kidney failure and dementia?
Dr. Black: Yes, that is pretty well established. In fact, I think hypertension is the poster child for the value of clinical trials. We take people with an elevated blood pressure, we compare either different regimens or a placebo, and we show that the rates of stroke and other events decrease, regardless of age or gender. That is the purpose of why we do this.
Dr. Roccella: What are we taking about in terms of the benefits of treating hypertension? Are we just going to lower our chances of heart disease or stroke by 1 percent or is the advantage substantial?
Dr. Black: For strokes, the data is pretty convincing that there is a 40 percent to 50 percent reduction. For heart failures, it is more like 50 to 60 percent. For heart attacks, it is about 20 to 25 percent. So these are very profound and robust changes that we have achieved.
Dr. Roccella: Those are pretty powerful numbers.
Dr. Black: Yes they are. And for some reason we do not focus enough on them. We've got to make sure that everybody realizes how important reducing blood pressure is.
Ms. Houston Miller: The good news also is that even if we cannot get people to their blood pressure goal levels, there is still a very significant reduction in risk when we can lower blood pressure by even 10 percent, 20 percent, and 30 percent. This is an important point.
Click these links to read more from Sister to Sister’s Expert Roundtable on High Blood Pressure:
Introduction
Blood Pressure Basics
Symptoms & Screening
Treatment Benefits
Treatment Options
Drug Side Effects
Drug Interactions
Medication Costs
Prehypertension
Aging's Impact
High-Risk Groups
Future Goals