- The Washington Times - Tuesday, June 3, 2003

If you weren’t already disheartened by stories about the spread of SARS and lawyers battling the evils of Oreos, the latest news from the National Heart, Lung and Blood Institute probably won’t make you feel any better about your health. The Institute has released new guidelines that turn people with previously normal blood pressure into “pre-hypertensive” patients-disease-free for the moment, but presumably inching toward full-blown high blood pressure.

The news brought more than a few grumbles from the audience convened at the announcement of the guidelines, many of whom are among the 22 percent of American adults who fall into this new at-risk category.

Some were convinced that the scientists and the doctors were conspiring to pull the rug out from under us again like they did a few years ago when many of us became overweight overnight when the “body mass index” was revised. Why was this happening? How could previously healthy numbers suddenly turn into a warning signal?

Part of the reason is that clinical research evidence accumulates, and ideas about what’s risky and what’s not change as a result. Claude Lenfant, director of the Institute, says he can remember a time when doctors asked their patients to add 100 to their age to find their “normal” blood pressure. Researchers have completed more than 30 large clinical studies of blood pressure treatment and prevention since the last guidelines were issued in 1997, uncovering some valuable information along the way.

The studies suggest the risk of developing and dying from high blood pressure-related diseases are much greater than previously thought. Both men and women age 55 have a 90 percent risk of developing high blood pressure, and Lenfant says that “the harm starts long before people get treatment.”

But there’s a larger lesson in the new guidelines that has nothing to do with numbers and everything to do with behavior: High blood pressure is just one part of what clinicians are beginning to call “the lifestyle syndrome” — an alarming rise in disease caused by obesity, inactivity and other risky health conduct like smoking, drinking to excess or engaging in unsafe sex.

Not surprisingly, people in the new pre-hypertensive category are urged to eat better, lose weight, get more exercise, drink in moderation and forget smoking. Even people who already have high blood pressure can forgo medication and lower their risks with a purely behavioral approach, according to recent research.

“The bottom line is that Americans must change how they think about blood pressure. The sooner they take action, the better,” says Dr. Ed Rocella, coordinator of the National Institutes of Health education campaign about the new guidelines. “It’s vital that they adopt a heart-healthy lifestyle early, even if their blood pressure is normal.”

And in doing so, maybe they’ll also change how they think about health.

It’s rare that we wake up one day and find our blood pressure has skyrocketed out of the healthy range.

For most of us, high blood pressure steadily creeps up, the buildup of age and those unhealthy behaviors that make up “the lifestyle syndrome.”

In that sense, it shouldn’t take a number to tell us that we’re “at-risk.” High blood pressure is the most common diagnosis made by primary care physicians, providing an excellent point for doctors and patients to begin collaborating on a plan of action that will help people live as well and for as long as they can, no matter what the numbers say.

Jessie C. Gruman, a social psychologist, is president of the Center for the Advancement of Health.

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