ANN ARBOR, MI - At 9:30 this morning in Washington, D.C., national health officials will unveil a new "road map" for finding and treating high blood pressure, and cutting the massive, deadly toll it takes each year on America's health.

Back in Ann Arbor, Michigan, a family doctor will be smiling.

Lee Green, M.D., MPH, is a family physician at the University of Michigan Health System, who sees patients at the Briarwood Family Practice Center. He's also a member of the elite committee that compiled and wrote the new national guidelines for elevated blood pressure and its more serious form, hypertension.

Green was the only family physician and the only Michigan doctor to serve on both the 10-member executive committee and the entire national committee. He lent his expertise as a primary care physician, as well as a clinical epidemiologist and specialist in evidence-based medicine.

"It was good to bring the family doctor's perspective to this effort, because family practitioners take care of most of the high blood pressure patients in the U.S.," Green says. "These guidelines give family doctors and general internists a cutting-edge tool for managing patients with elevated blood pressure and full-blown hypertension."

The guidelines, which will also be published today in the Journal of the American Medical Association, are designed to help doctors across America give the best-possible care to people with high blood pressure - including those who still have a chance to stave off the condition through diet and exercise.

In a few pages and flowcharts, the guidelines give the best-available and most current knowledge about what hypertension treatments work best for patients according to their blood pressure levels and other conditions.

According to federal government health data, about 90 percent of middle-aged Americans will develop high blood pressure in their lifetime, and nearly 70 percent of people with high blood pressure do not have it under control. Many people with high blood pressure have no idea they have the condition. High blood pressure and hypertension are closely linked to heart disease and stroke, the nation's number one and number three most deadly diseases.

The new report puts strong emphasis on optimal treatment of high blood pressure with effective lifestyle changes and medications, and prevention of full-blown hypertension in people who have elevated blood pressure or "pre-hypertension."

Blood pressure is expressed in two numbers, one on top of the other, that measure the pressure of blood traveling in blood vessels, both during and between heartbeats. The top number is the "systolic" blood pressure, and the bottom number is the "diastolic" blood pressure. Pressures are measured in millimeters of mercury, or mm Hg.

Pre-hypertensive people are identified as those whose systolic blood pressure is between 120 and 139 mm Hg, or whose diastolic blood pressure is between 80 and 89 mm Hg. Hypertension is defined as greater than 140 mm Hg systolic, or 90 mm Hg diastolic.

The new guidelines point out that in people older than 50 years, systolic blood pressure of more than 140 mm Hg is a much more important risk factor for cardiovascular disease than elevated diastolic blood pressure.

The authors also stress that a person's risk of developing cardiovascular disease of any kind doubles each time their systolic blood pressure goes up 20 units or their diastolic pressure goes up 10 units.

The new guidelines are officially called the JNC-7 report, short for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The effort to compile and prepare the guidelines was funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health.

Green, an associate professor in the Department of Family Medicine at the U-M Medical School, also served on the last joint national committee on this subject, which published its recommendations in 1997. But he notes that a lot has been learned since then about the best way to prevent and treat hypertension.

For example, he cites newly published findings on a class of medicines called thiazide-type diuretics, which have been around for years and are inexpensive. A recently published study showed that these drugs are just as effective in lowering blood pressure and preventing heart attacks as more costly and newer drugs, and better than other drugs in preventing stroke and heart failure.

"We now have good data comparing one treatment to another, and for almost all patients the thiazide diuretics turn out to be the best choice," Green says. Other types of drugs, such as calcium channel blockers (CCBs) and angiotensin-converting enzyme (ACE) inhibitors, may be appropriate for other patients. And evidence shows that many patients who need medication to control their blood pressure should take more than one medicine.

Other recent findings show that the DASH diet, a sensible and easy-to-follow nutrition plan, can lower blood pressure. For information, visit www.nhlbi.nih.gov/health/public/heart/hbp/dash.

Perhaps most importantly, the guidelines note, doctors can prescribe all the effective treatments and lifestyle changes they can, but if patients aren't motivated to follow those prescriptions, they won't succeed in getting their blood pressure under control.

May is National High Blood Pressure Education Month. The NHLBI web site, hin.nhlbi.nih.gov/nhbpep_kit/index.htm, has information on blood pressure and ways to lower it.

UMHS has fact sheets on high blood pressure atwww.med.umich.edu/1libr/heart/heart00.htm#highbp00.

The Centers for Disease Control and Prevention's cardiovascular site is www.cdc.gov/cvh.

Written by: Kara Gavin

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