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(This article originally appeared in the August 2008 issue of
Harvard Women's Health Watch.)
About 73 million Americans — nearly half of them women — have
hypertension (high blood pressure), a condition that propels
blood too forcefully through blood vessels, increasing the risk
of heart attack, heart failure, stroke, and kidney damage. If you
have hypertension or borderline hypertension, you should be
checking your blood pressure at home on a regular basis. That's
the major recommendation in a joint statement from the American
Heart Association (AHA), the American Society of Hypertension
(ASH), and the Preventive Cardiovascular Nurses Association
The expert panel that issued the statement was chaired by Dr.
Thomas G. Pickering of Columbia University. The statement itself
was jointly published online May 22, 2008, in the journal
Hypertension and the Journal of Cardiovascular
Nursing and in print in the Journal of the American
Society of Hypertension (May 2008) and the Journal of
Clinical Hypertension (June 2008). Although other guidelines
on managing hypertension have endorsed home blood pressure
monitoring, this is the first time experts have given detailed
advice about its use.
Doctors once hesitated to prescribe medication until a patient's blood pressure reached 160/100. Anything below that level was deemed "mild hypertension" and not considered dangerous, so many doctors worried that the drugs' potential side effects might outweigh their benefits. These perceptions turned out to be false. Research has firmly established the value of treating stage 1 hypertension (140/90 to 159/99 mm Hg) with drugs, if necessary.
For those with diabetes or kidney disease, medications may be necessary at pressures as low as 130/80. And today, blood pressure can be controlled with lower doses of medications, meaning there is less chance of side effects.
Doctors can choose from an abundant selection of antihypertensive medications, including many preparations that combine one or more drugs. Many newer antihypertensive drugs have a slightly different chemical structure from older drugs but produce nearly identical effects in the body. Others act in entirely different ways. Doctors can tailor treatment to the individual patient and can often prescribe a drug that controls blood pressure, produces few or no side effects, and, hopefully, protects against complications. In addition, it's often possible to use a single medication to treat both the hypertension and accompanying medical problems, like congestive heart failure.
Blood pressure tends to increase with age as arteries stiffen.
From midlife onward, the focus should be on the systolic number,
which tends to rise more sharply in women after menopause than in
men of similar age.
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