By Peggy O'Farrell
The Cincinnati Enquirer

Millions more Americans could be having "the talk" about diet and exercise with their physicians after the recent release of new guidelines that establish a warning zone for high blood pressure.

The good news, local experts say, is that the new guidelines will force doctors and consumers to take more aggressive action against the threat of high blood pressure and its consequences - heart disease, stroke and kidney failure.

BY THE NUMBERS

Blood pressure measures the force of blood against the arterial walls, and is expressed in two numbers. The systolic pressure, or top number, measures the force as the heart beats. The diastolic pressure, or bottom number, measures the force as the heart relaxes between beats. A person's blood pressure would be expressed, for example, as 120 over 80 millimeters of mercury (the measurement scale used on a sphygmomanometer - sometimes call a sphygmometer - or blood pressure cuff).

WHAT YOU CAN DO

Changes to lower blood pressure: • Follow a healthy diet high in fruits, vegetables and grains, and low in fat. • Reduce salt and sodium in your diet. • Maintain a healthy weight for your height. • Exercise regularly. • Limit alcohol intake. • Stop smoking. Source: The National Heart, Lung and Blood Institute

The bad news is that consumers don't want to take steps to control blood pressure now, so asking them to work harder won't be an easy sell.

"Everybody's compliant after the heart attack or stroke," says Dr. Keith Melvin, an internist with Alliance Primary Care. "Prior to that, most people figure it's going to happen to the other guy."

A blood pressure of 140/90 millimeters of mercury is still considered high. But the federal guidelines announced last week and outlined in this week's Journal of the American Medical Association establish "prehypertension" blood pressure levels to indicate that someone doesn't have high blood pressure, but is likely to in the future.

Someone whose blood pressure measures between 120/80 and 139/89 is now classified as prehypertensive and should be counseled to make lifestyle changes to prevent high blood pressure. "Normal" blood pressure is classified as anything under 120/80.

The higher a person's blood pressure is, the more likely he or she is to suffer a heart attack or stroke, says Dr. Mark Bibler, an internist with the University of Cincinnati.

"What's changed is a greater awareness that even blood pressure as low as 120/80 has a greater risk of heart disease or stroke than, say, a blood pressure of 110/70," Bibler says.

Hypertension is called the "silent killer" because it has no symptoms. Most people with high blood pressure feel just fine until they suffer a heart attack or a stroke or their kidneys begin to fail.

An estimated one in four Americans has high blood pressure, and, though the condition can't be cured, it can be controlled with medication and lifestyle changes.

Thomas Stone, 50, of Avondale learned he had high blood pressure when he went to a health fair a few years ago.

He began taking medication, cut out salt and caffeine and started exercising regularly. He also started using lots of fresh garlic when he cooks to help control his blood pressure.

But even with all this hard work, his most recent blood pressure reading was 126/89 - still too high by the new standards.

His response?

"Oh, man."

Controlling hypertension isn't always easy, doctors say. Many patients, including Stone, need more than one medication. Stone takes three.

The medications can cause side effects, including fatigue and frequent urination, that make patients feel worse than they did before they started taking the medicine.

Those side effects, not to mention the cost, often lead patients to stop taking their medication.

"Then they're at the same risk they were all along. It's very difficult," Melvin says.

The guidelines urge doctors to be more aggressive in prescribing medications, pointing out that about two-thirds of the people who have been diagnosed with high blood pressure don't have it under control.

The new rules also emphasize the use of diuretics, "which are effective, safe and cheap," to treat hypertension, says UC kidney specialist Dr. Max Reif.

The guidelines, established by the National High Blood Pressure Education Program Coordinating Committee, represent a major change in mindset for physicians, Melvin says.

"For years, we've been concentrating on keeping the top number under 140, and we've had that number set too high."

E-mail pofarrell@enquirer.com