STUDY: High blood pressure is rampant within reach of health system

Wednesday, August 15th 2001, 12:00 am

By: News On 6

BOSTON (AP) _ Several million Americans could lower their risk of heart disease and stroke if they were simply treated correctly for their high blood pressure, according to a new study.

The vast majority of people with uncontrolled hypertension have health insurance and see a doctor, despite the perception that poverty and lack of health care are largely to blame, researchers said.

``Although lack of health care is a problem for some people, the big hunk of these people are right under the health care system's nose,'' said Dr. David Hyman, lead author of the study done at Baylor College of Medicine in Houston.

Hyman and colleague Valory Pavlik, both specialists in community health, studied data from an earlier survey of 16,095 adults age 25 or older. Their findings are published in Thursday's New England Journal of Medicine.

An estimated 42 million Americans have high blood pressure, the study says. Of those, only 10 million are successfully treating it.

According to the study, 92 percent of adults with untreated or unsuccessfully treated high blood pressure have health insurance. Also, 72 percent who are unaware of their condition or letting it go untreated have visited a doctor at least once in the previous year.

The researchers acknowledge that blacks are more apt than whites to develop high blood pressure, a long-known phenomenon often blamed on inadequate health care among many poor people. But the study found that the same percent of whites and blacks with high blood pressure are successfully treated: 24 percent for each group. Hyman said that suggests strides in public awareness in the black community.

Dr. Richard Pasternak, a cardiologist at Massachusetts General Hospital in Boston, said the findings will be an eye-opener to some people who watch public health trends. ``Often people have looked at this problem globally and said it must be related to inadequate health care coverage,'' he said.

The researchers said 77 percent of people with high blood pressure don't know about it, choose not to treat it, or treat it without success.

They blame the high number partly on the reluctance of many doctors to treat some cases aggressively enough, especially in elderly patients. The study found most cases of unsuccessfully treated high blood pressure among patients 65 and older.

The most commonly accepted trigger for treatment is a blood pressure reading of more than 140/90. The first number represents the so-called systolic pressure while the heart is contracting; the second number, diastolic pressure during the heart's resting phase.

Doctors almost universally agree that diastolic pressure above 90 should generally be treated. But many doctors fear that drugs knocking down mildly high systolic pressure _ between 140 and 160 _ may do harm by also lowering diastolic pressure and cutting off blood flow to the brain and other organs. Especially in elderly people, the theory goes, mental function could be hindered.

But Dr. Aram Chobanian, a heart specialist who is dean of Boston University School of Medicine, said the latest studies don't bear out such worries. Chobanian, who wrote an accompanying editorial in the journal, said there are many patients who need more aggressive treatment: ``That's where the focus ought to be.''

Doctors familiar with the study said other factors also contribute to the high level of uncontrolled blood pressure, like patients who don't follow medical advice and doctors who are short on time for treatment and counseling of patients.