The News on High Blood Pressure Gets Worse: Even Mild Hypertension Can Be Dangerous, Warns Dr. Stevo Julius

updated 09/03/1990 AT 01:00 AM EDT

originally published 09/03/1990 AT 01:00 AM EDT

It is a quiet, relentless killer. More than 58 million Americans suffer from high blood pressure; each year several hundred thousand die from diseases related to it. Hypertension submits the heart and other organs to potentially fatal stress, and now researchers have found that even a slightly elevated blood pressure can be harmful. A startling study published last month in the Journal of the American Medical Association indicates that an estimated 15 million people with only minimally elevated blood pressure face health risks more serious than previously thought.

"We were surprised to find that individuals with even very minor blood-pressure elevation already show signs of damage to their blood vessels and heart," says Dr. Stevo Julius, 61, the principal author of the study. Fortunately the news is not all bad. According to Julius, a physician and researcher at the University of Michigan, hypertension is one medical killer we can all do something about. He spoke with correspondent Julie Greenwalt.

How would someone know if he or she is suffering from hypertension?

Hypertension is the classic silent disease. There are no warning signs. The only way to diagnose it is to take your blood pressure.

What does a blood pressure reading tell you?

There is a high and low value with each beat of the heart. The higher—systolic-number relates to the pressure, or force, that the heart has to develop to pump out the blood. The lower—diastolic—number tells how low the pressure gets before the next beat of the heart.

We have known for some time that repeated readings exceeding 160 over 95 indicate a medical condition which is potentially fatal if not treated. A reading of 140 over 90 is considered borderline hypertension. In our recent research we found that even blood-pressure elevation of this magnitude, once considered minor, also can have serious consequences.

What is thought to be a healthy reading?

An ideal reading would be 120 over 75 with plus or minus 10 on either side. Low blood pressure is not dangerous unless it produces symptoms such as dizziness in an upright position.

Why is high blood pressure so dangerous?

If I take a garden hose and put my finger over the end, the water pressure will build up and could eventually cause the hose to rupture. Likewise, blood vessels under continuous high pressure will suffer abnormal wear and tear. High blood pressure can kill or disable you in several ways. It can destroy the kidneys, which are a conglomeration of small blood vessels. A weakening of the blood vessels in the brain could result in a stroke. The heart—the pump that has to provide all the pressure—will get bigger and stiffer from overwork, which could eventually result in heart failure.

What causes blood pressure to rise into the danger zone?

We don't know the exact cause. But there are several factors that increase the risk of contracting the disease. Heredity is one. Hypertension clearly runs in families. High blood pressure and weight problems often go hand in hand, though we don't fully understand why. And about 20 to 25 percent of people with hypertension are adversely affected by salt and must carefully adjust their diet.

What about smokers and drinkers?

Smoking, though it does not increase your blood pressure per se, is terrible for your blood vessels. And there is a strong correlation between alcohol consumption and high blood pressure. Contrary to common belief, however, coffee is one thing which does not affect blood pressure.

Is there a cure for hypertension?

We cannot cure it because we do not know the cause. But luckily it is one of the few diseases that can be controlled simply by treating the symptoms. If you have a brain tumor, aspirin is great for the headache but will not stop the growth from getting larger. But when you treat hypertension by taking steps to lower your blood pressure, the prognosis becomes almost normal. That is exceptional in medicine.

What kind of treatment is available?

Medication is essential for controlling critically high levels of blood pressure. In borderline cases, however, it is important first to try to lower the blood pressure by other means. Weight reduction often has a very positive effect, as does salt restriction for those who are sensitive to salt. And a recent study in Australia showed that proper exercise—strenuous aerobic exertion for 30 minutes, every other day—can reduce blood pressure as much as mild medication.

Is hypertension a problem doctors sometimes overlook?

A doctor might tell a patient, "Look, your blood pressure doesn't require treatment today. But watch it." It is now clear, however, that even moderately high blood pressure can cause heart damage. So it is important that we as physicians try to get in the game early and help develop a serious program of prevention.

At what age should blood pressure monitoring begin?

One of the surprising findings of our research is that higher blood pressure is a problem that begins in childhood. This is not just a fleeting condition. Our data also suggests that weight problems begin to be evident in the late teens. So that is a good time to begin dietary intervention and help establish life habits that will reduce the risk of hypertension.

Any hopeful last words on hypertension?

It is never too late. Whatever your age, do monitor your blood pressure. It could save your life.

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