New information gathered by the National Heart, Lung, and Blood Institute's Framingham Heart Study, and reported in the April 22 New England Journal of Medicine, indicates that a five- to tenfold increase in use of antihypertensive medication from the 1950s through the 1980s was accompanied by striking declines in the prevalence of the highest blood pressure levels (3 and 4) down to more moderate levels (1 and 2). High blood pressure at stage 3 is systolic blood pressure of 180 to 209 mm Hg or diastolic blood pressure of 110 to 119 mm Hg. Stage 4 high blood pressure is systolic blood pressure of at least 210 mm Hg or diastolic blood pressure of at least 120 mm Hg. The study further notes that the favorable trends in hypertension treatment and control were accompanied by a decline in hypertensive target organ damage in the form of left ventricular hypertrophy (LVH), which is an important risk factor for both cardiovascular disease and fatal coronary heart disease.
Despite this encouraging news, however, it is important to note that the majority of coronary heart disease and stroke occurs at lower stages of hypertension. And, although hypertension levels declined over the 4 decades between 1950 and 1989, recent data from the National Health and Nutrition Examination Survey (NHANES) reveal that a national downward trend in blood pressure control rates slowed in the 1990s and actually headed slightly higher. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), which NHLBI released in November 1997, reported this disturbing trend.
JNC VI also noted a slight rise in the rate of stroke, increases in both end-stage renal disease and heart failure, and a leveling in the death rate for people with coronary heart disease. These indicators signal the clear need for physicians and patients to redouble efforts to prevent and treat hypertension.
The JNC VI guidelines urge a populati
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NIH/National Heart, Lung, and Blood Institute