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When normal just isn't enough
By WES ALLISON So your blood pressure hasn't been perfect, but it's still in the normal range. This year, don't expect your doctor to tell you to keep up the good work. A recent study found that millions of people with blood pressure at the high end of the normal range face double the risk of heart disease. Local doctors say they plan to use the findings to urge patients to push their blood pressure lower. The findings confirmed what many doctors had thought for years, and patients with high-normal blood pressure can expect to hear what people with high blood pressure already have been hearing: Cut back on the salt and the fat. Lose some weight. Exercise. "The one thing this study did was kind of confirm, in an official way, that cardiovascular mortality and morbidity is less if you keep the blood pressure lower," said Dr. S.K. Rao Musunuru, a Hudson cardiologist and president-elect of the Florida-Puerto Rico affiliate of the American Heart Association. "That will help family doctors, because now they have a confirmationary study. It's not just the feeling or thinking, but it's true," he said. "That will actively prompt more physicians to follow it." The study, yet another product of the 53-year-old Framingham Heart Study, was published earlier this month in the New England Journal of Medicine. Over the course of a decade, it found that people with a high-normal blood pressure were 1.5 to 2.5 times more likely to suffer a heart attack or stroke than people whose blood pressure is solidly in the normal range. High-normal blood pressure is defined as a systolic, or upper, pressure of 130 to 139 and a diastolic, or lower, pressure of 85 to 89. About 13-million Americans fall into this range, the study said. High is considered 140 over 90 and higher. Optimal is considered 120 over 80 or lower. "The value of this article is proving what we thought is so," said Dr. Stephen Glasser, a cardiologist and professor at the University of South Florida College of Medicine. And, he added, "It might give great emphasis to lifestyle modification for that group, and ... I think it does add (strength) when we as medical caregivers can say, "Here's a study that shows you're at greater risk.' " The researchers used 12 years of information gathered on nearly 7,000 men and women enrolled in the Framingham study. Among women, just 1.9 percent of those with optimal blood pressure suffered a cardiovascular event, including heart attack, stroke or congestive heart failure, compared with 4.4 percent of those with high-normal pressure. Among men, 10.1 percent with high-normal pressure suffered a cardiovascular event, compared with 5.8 percent of men with optimal blood pressure. An editorial accompanying the Journal study called for more research to determine whether people in the high-normal range can benefit from blood pressure medications. Drugs clearly have shown to be helpful to people with high blood pressure, but that doesn't necessarily mean the benefits of those drugs will outweigh the risks among people with high-normal blood pressure. It is, however, clear that increasing exercise and improving diet do help. Dr. George Harris, assistant director of the family practice residency at Bayfront Medical Center in St. Petersburg, said he discussed the report with his medical students, and he expects teachers in other medical programs to do the same. "It's important that we address those individuals, look at other risk factors, and decide if, instead of waiting, we need to be treating them earlier," said Harris, who also is president of the Florida Academy of Family Physicians. "This is tuning into physicians and saying, "Hey, we need to be a little more aggressive. We need to get these folks as close to 120 over 80 as possible.' "
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From the Times state desk
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