Physicians are finally coming to grips with the realization that they can no longer responsibly tell patients not to worry about their blood pressure if it is less than 140/90.
More and more studies are demonstrating that every incremental increase in blood pressure increases the danger of a cardiovascular event.
The statistics from the Women's Health Initiative (WHI) Study tell the tale of the impact of high blood pressure on postmenopausal women: Even those participants with blood pressures in the prehypertension range — that is, blood pressures not yet considered high — had a significantly greater risk of cardiovascular events and death than women with normal blood pressures.
About 40 percent of the nearly 61,000 postmenopausal women enrolled in the WHI study had prehypertension, defined as a systolic pressure (the top number) between 120 and 139 mm Hg or a diastolic pressure (the bottom number) from 80 to 89 mm Hg. Since another 35 percent had full-blown hypertension (blood pressures of 140/90 or greater), only 25 percent of the women in this study had normal blood pressures.
Now take a look at these statistics: Compared to women with normal blood pressure, during a 7.7-year follow-up, those with prehypertension had a 58 percent higher risk of cardiovascular death, a 76 percent increase in nonfatal heart attacks, and a 93 percent greater risk of stroke. (Not surprisingly, during the follow-up period women with hypertension had a 300 percent greater risk of cardiovascular death and those with diabetes a 250 percent higher risk.)
Startlingly, the researchers point out that prehypertension was associated with a greater risk of cardiovascular events than the widely known risk factor of smoking, which increases this risk by 34 percent.
Long before they reach menopause, women are urged to adopt lifestyle measures — weight control, regular exercise, and reduced sodium intake — that may prevent the development of prehypertension, lower blood pressure in those with prehypertension, and prevent the progression of prehypertension to even more dangerous hypertension.
Most doctors today are still reluctant to recommend drug treatment for women (or men) with prehypertension. In view of these study results, however, prehypertension should probably be added to the list of risk factors that affect decisions on whether to begin aspirin treatment or medications to lower LDL cholesterol levels.
