High Blood Pressure Still #1 Killer

COL#255- 8/27/25

HIGH BLOOD PRESSURE STILL #1 KILLER
By
Richard Davis

It’s worth checking in on some basic health care issues from time to time because expert guidance changes and new developments are always worth considering. When it comes to blood pressure experts have long recommended that a person’s blood pressure should be at or below 140/90, but in recent years recommendations are for that to be 130/80.

According to a recent article on the Medscape web site, “The target blood pressure level for adults remains below 130/80 mm Hg, but drug therapy should be initiated sooner, according to new guidelines published Thursday by the American Heart Association (AHA) and American College of Cardiology (ACC). Eleven other medical organizations endorsed the new guidelines, which replace those issued in 2017. “We’re trying to get started earlier in the process of preventing cardiovascular disease,” said Daniel W. Jones, MD, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, who chaired the guidelines committee. Almost half of American adults have hypertension, according to the AHA.”

Hypertension is the leading cause of death and disability worldwide and it is the most prevalent and modifiable risk factor for cardiovascular disease. There are many issues that relate to the control of blood pressure, including the methods used to measure it as well as the approach to drug therapy. Most experts recognize the fact that weight loss can lower blood pressure.

The new guidelines for blood pressure haven’t changed very much. A person is considered to have elevated blood pressure if systolic is in the 120-129 range and diastolic is over 80. There are two stages of hypertension. Stage one is when blood pressure is 130-139 systolic and 80-89 diastolic. Stage two is over 140 systolic and over 90 diastolic. Those numbers can also vary with people who have chronic diseases.

Elevated blood pressure is called the silent killer because it has no symptoms for many years. As pressure remains high for a long period of time the heart begins to show signs of strain from pumping against high pressure in blood vessels. Eventually the heart cannot pump effectively and fluid backs up into the lungs. This is the basic scenario in heart failure. Once a person develops heart failure, after many years of untreated high blood pressure, the changes in their heart are irreversible. Medication is used to minimize symptoms, but there is no cure for heart failure short of a transplant.

The new blood pressure treatment recommendations call for health care providers to start treatment as early as possible. This is a clear recognition of the insidious nature of hypertension. A cynical person might want to believe that the suggestion for early treatment is helping the drug companies make more money. That is true, and I’m sure they are very happy about this recommendation, but early treatment does make very sound clinical sense.

Most of the newer drugs used to treat high blood pressure can be costly and that is a problem that never goes away, especially in the United States.

I suspect that the percentage of people with hypertension who never fill their prescriptions or who stop taking recommended medications is high.

This creates a vicious cycle where those who can’t afford drugs get sicker and sicker and run up high health care bills and create burdens on the health care system. If there was one disease that this country should have a laser focus on it is high blood pressure. Controlling the blood pressure of a few million more people would not only create a healthier society but would also protect the health care system from unnecessary and expensive treatments. Drug companies would have to be part of the solution and I don’t see that happening any time soon.