The Silent Epidemic

Samuel J. Mann, MD
New York-Presbyterian Hospital Weill Cornell Medical Center

Editor's note: A close relative of mine who had hypertension might have avoided a serious stroke if he had only been able to follow the advice given here.
-- Marjory Abrams


Don't assume that your blood pressure is fine just because your last test results were good. Recent guidelines have revised the optimal standard downward. The previously "normal" reading of 140/90 is now far from acceptable.


Fact: The optimal blood pressure reading currently is 115/75. Health risks begin to rise when blood pressure reaches the range of 120/80 to 139/89. People in this range are considered to have prehypertension and are at increased risk of developing full-fledged hypertension, which can cause stroke, heart attack, kidney failure and other health problems.




Hypertension is a condition in which the blood is pumped through the body under abnormally high pressure. Experts used to think that a rise in diastolic blood pressure (the second number -- the amount of pressure in your arteries when your heart is at rest between beats) was the main contributor to cardiovascular disease. Recent findings show that systolic pressure (the first number -- the pressure your heart generates when pumping blood through your arteries) is the one to watch. But health risks increase when either number is elevated.


Controlling hypertension can reduce the incidence of stroke by 40%... heart failure by more than 50%... and heart attack by 25%. One in 11 deaths in hypertension patients can be prevented for every 12-point reduction in systolic pressure that is maintained for at least 10 years.




Hypertension is a "silent" disorder that rarely causes symptoms. The only way to find out if you have it is to get checked by a doctor or nurse or to test yourself with a home blood pressure monitor.


Simple steps can significantly reduce hypertension. Unfortunately, most people choose to ignore this important advice. Don't be one of them...

  • Check your blood pressure at home. As many as 20% of Americans have "white coat hypertension," blood pressure elevation that occurs only in a doctor's office. These people may be misdiagnosed with hypertension and spend years taking unneeded drugs. If you have high blood pressure, check your pressure at home about twice a week at varying times. Take three readings each time, waiting a few minutes between each one. See your doctor if the readings average above 120/80.

Helpful: Use an electronic blood pressure monitor. Reliable models are available now for less than $100. Gauges with arm cuffs are more accurate than ones with finger or wrist cuffs. Manual mercury gauges are accurate but hard to use.

  • Limit sodium and boost potassium. Sodium causes the body to retain fluids, elevating blood pressure. Potassium aids in sodium excretion, lowering pressure.

Sodium: Pressure can be lowered by reducing your daily salt intake to below 1,600 milligrams (mg). Some restaurant meals and baked goods are among the main sources of dietary salt. Request salt-free dishes, and buy low-salt baked goods.


Potassium: The recommended daily amount is 3,500 mg -- but most Americans get only about 2,600 mg. You can ensure enough potassium by eating more fruits and vegetables, including citrus fruits, apples, bananas, apricots, cantaloupe, white and sweet potatoes (especially with the skins), tomatoes, spinach, mushrooms and peas. Or take a daily multivitamin/mineral supplement that contains potassium.


Restrict salt and eat a healthful diet -- minimizing processed foods and emphasizing fresh fruits and vegetables, legumes and whole grains -- to lower blood pressure by as many as 20 points. That's often enough to avoid medication.

  • Maintain a healthful weight. Being overweight is a primary cause of hypertension, and the risk is highest if you carry most of the weight around your waist or upper body. Women whose waists measure 35 inches or more and men whose waists measure 40 inches or more are much more likely to develop hypertension, diabetes and heart disease.

Weight loss can help lower blood pressure. It also helps blood pressure drugs work more efficiently so you can take less medication.

  • Exercise most days of the week. Aside from its role in promoting weight loss, exercise boosts excretion of sodium through perspiration. Exercise also causes the heart to pump more efficiently. As little as two to three one-hour exercise sessions a week can reduce blood pressure by five to 10 points.
  • Drink only moderately. Some alcohol may be beneficial because it is associated with reduced coronary risk. In excessive amounts, however, it raises heart rate and blood pressure. Up to two drinks a day for men and one for women should not hurt blood pressure.
  • Don't smoke. Smoking constricts arteries and promotes blood-blocking fatty deposits (atherosclerosis). Smoking one cigarette elevates blood pressure for about half an hour -- a pack a day elevates blood pressure for much of the day. Nicotine patches and stop-smoking programs can double your chances of success compared to quitting cold turkey.
  • Deal with painful emotions. Preliminary research suggests that suppressing emotions, including those related to childhood trauma, such as abuse, can contribute to severe hypertension. Burying feelings stimulates the sympathetic nervous system, elevating heart rate and/or causing blood vessels to constrict and raise blood pressure.

Red flag: People who say they never get depressed or upset are the ones most likely to have repressed emotions. This coping style also may be associated with other unexplained problems, such as irritable bowel syndrome or pelvic pain.


Blood pressure sometimes can be normalized when patients deal with repressed emotions in therapy.




Within the past decade, most doctors have switched patients to newer classes of antihypertensive drugs, such as ACE inhibitors and angiotensin II receptor blockers, because they were thought to be superior to "old-fashioned" diuretics, which reduce the amount of fluid in your body.


Not true. Diuretics are just as effective for most patients and less expensive. They also have the added benefit of causing the body to excrete excess sodium.


Many people with high blood pressure, particularly those over age 55, should begin treatment with diuretics. However, some patients may respond as well or better to other drugs. Also...

  • Ask your doctor about "step-down" treatment. If your hypertension has been well controlled for a year or more, you might be able to decrease the dose or number of medications, especially if you're exercising regularly and maintaining a healthful weight.
  • See a specialist. If your blood pressure stays high despite medical treatment or if you're taking two or more drugs to control it, see a hypertension specialist. The American Society of Hypertension (www.ash-us.org) maintains a state-by-state registry of member physicians.

Bottom Line/Personal


(Kay’s Note:  Those who are overweight or underweight typically lose or gain to within 10-15 pounds of their ideal weight on the SCD . . . which ultimately lowers blood pressure. Exercise can take care of the rest of the weight.)