It's been widely reported that an estimated 72 million Americans have high blood pressure (hypertension)—but the fact that only 35% of the people who are being treated for the condition actually have it under control comes as a surprise to most people.

There are a variety of effective treatments, ranging from diet, exercise and supplements to dozens of medications. So why don't more people keep their hypertension in check?

250,000 American Lives Are At Stake

Even though one in three adults has hypertension, about one-third of them don't know it. That's largely because hypertension-defined as a systolic (top) number of 140 millimeters of mercury (mm Hg) or higher and/or a diastolic (bottom) number of 90 mm Hg or higher-usually produces no outward symptoms until organ damage has occurred. (For example, blood vessels in the kidneys can be harmed by untreated hypertension, leading to kidney failure) That's why it's important to have your blood pressure checked at least once a year.

Danger: If you have hypertension that is not being adequately treated, your risk for stroke, heart attack, heart failure and kidney failure is greatly increased. This year alone, uncontrolled hypertension will cause or contribute to the deaths of more than a quarter-million Americans, according to the American Heart Association (AHA). How to protect yourself…

Treat It Early

Many doctors still "start low and go slow" when prescribing antihypertensive medications—a holdover from the days when blood pressure drugs invariably produced unwanted side effects, such as cough, dizziness and headache, But many of today's anti-hypertensives, particularly the angiotensin II receptor blockers (ARB)--a class of hypertension drugs including valsartan (Diovan) and losartan (Cozaar)are generally well-tolerated.

Recent research shows that aggressive early treatment of hypertension can be lifesaving for patients who are at high risk for cardiovascular disease.

Latest scientific evidence: At the University of Michigan, we recently completed a large-scale international clinical trial comparing the effectiveness of an ARB with that of a calcium channel blocker (CCB)—a class of hypertension medication including amlodipine (Norvasc) and felodipine (Plendil)—for reducing cardiac deaths in people with hypertension and at least one additional cardiovascular risk factor (such as diabetes, high cholesterol, previous heart attack or stroke). Over an average of four years, we didn't see a significant difference between the two drugs' abilities to control blood pressure and reduce related deaths. By the end of the study, patients in both treatment groups had achieved good blood pressure control.

What did appear to make a crucial difference was the speed with which blood pressure was lowered. Those patients who responded quickly to treatment—that is, their systolic blood pressure dropped by 10 mm Hg or more within the first month-were significantly less likely to suffer sudden cardiac death (an abrupt cessation of the heartbeat), heart failure or stroke.

Self-defense: If you have hypertension and at least one other cardiovascular risk factor, work with your doctor to quickly bring your blood pressure under control. If you have hypertension but no other risk factors, aim to lower your blood pressure within six months.

Be aware that a diuretic (a water-excreting drug often prescribed for high blood pressure), such as furosemide (Lasix) or chlorothiazide (Diuril), when used alone probably won't bring your blood pressure under control. Most people require two or more medications to achieve a normal blood pressure of less than 120/80 mm Hg. Two or more low-dose drugs can achieve significantly greater reductions in blood pressure, with fewer side effects, than a single high-dose drug, according to research.

*Women of childbearing age should not use these drugs-they can harm a fetus.

If you find it difficult to take more than one pill a day, ask your doctor about combination blood pressure medication (two antihypertensive drugs in a single pill), such as enalapril and hydrochlorothiazide (Vaseretic). In an analysis of studies, Columbia University researchers recently concluded that such medication reduces the risk for noncompliance (not taking medication as prescribed) by 24%.

Never Too Old For Treatment

Two-thirds of Americans age 75 and older have high blood pressure-and 90% of people in that age group will develop it by the end of their lives. As a result, many doctors accept high blood pressure as a "normal" part of aging and do not aggressively treat it in their oldest hypertensive patients.

Latest scientific evidence: A recent British trial comparing active treatment with an ACE inhibitor plus a diuretic) with a placebo unequivocally showed that lowering blood pressure reduces both stroke and death in adults in their 80s. The advantages of treatment were so striking that the researchers prematurely halted the study to allow all patients to receive the drugs.

Self-defense: If you're over age 80 and have hypertension, lowering systolic blood pressure by 12 mm Hg to 15 mm Hg can reduce your stroke and heart failure risk by as much as 35%, and your heart attack risk by as much as 20%.

Warning: A normal or low diastolic pressure does not offset an elevated systolic pressure. In fact, isolated systolic hypertension Chigh systolic pressure of 140 mm Hg or higher accompanied by normal diastolic pressure of less than 90 mm Hg) is the most common-and most dangerous-type of hypertension in older adults. This condition indicates that the arteries are stiff, which makes the heart work harder. If you have isolated systolic hypertension and your doctor is not treating it aggressively, find one who will.

Too Soon To Treat?

In May 2003, the AHA created a designation for "prehypertension—systolic pressure of 120 mm Hg to 139 mm Hg and/or diastolic pressure of 80 mm Hg to 89 mm Hg.

Latest scientific evidence: In our recent Trial of Preventing Hypertension (TROPHY) study, researchers found that people with a systolic pressure of 130 mm Hg to 139 mm Hg have a 63% chance of developing full-blown hypertension within four years. By giving prehypertensive patients an ARB drug for two years, and then stopping it, our study found that the progression to hypertension can be effectively postponed for up to two years, without further side effects.

Self-defense: The TROPHY study results hold promise for the estimated 37% of American adults on the verge of high blood pressure, but more research is needed before we can recommend antihypertensive medication for people with prehypertension. If you are prehypertensive, speak to your doctor about blood pressure monitoring it should be checked every six months) and preventive steps you can take, such as improving your diet and getting more exercise. Aim to exercise for 30 minutes every other day, with an activity, such as brisk walking, that raises your heart rate to 110 beats per minute.

I also recommend following the Dietary Approaches to Stop Hypertension (DASH) eating plan, which calls for eight to 10 servings of fruits and vegetables and two to three servings of low-fat dairy foods daily...sodium intake of no more than 2,400 mg daily...and moderate alcohol consumption (up to two drinks daily for men and up to one drink daily for women).

Blood Pressure Guidelines

  • Normal blood pressure—less than 120/80 mm Hg.
  • Prehypertension—120-139 mm Hg (top number) and/or 80-89 mm Hg (bottom number)
  • Hypertension—140/90 mm Hg or higher

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