HOW HIGH IS YOUR BLOOD PRESSURE? STAY WELL BY FOLLOWING LATEST GUIDELINES.

Byline: Evan Henerson Staff Writer

Elevated blood pressure or hypertension - the abnormally high rate at which blood is forced against the wall of the arteries - has typically been one of the easier doctor messages for a patient to brush aside.

But doctors say that those with high blood pressure are at far greater risk for strokes, heart attacks and kidney disease. The higher your blood pressure, the harder your heart is working and the more likely your arteries may harden.

``I call it the greatest silent killer in the world,'' says Dr. Afshine Emrani, a cardiologist at Encino Tarzana Regional Medical Center. ``The disease is so common that it's gotten past the eyes of physicians as an epidemic.''

Not that anybody in the medical profession is ignoring the prevention or treatment of high blood pressure. Quite the opposite. In May, the National Heart, Lung and Blood Institute - a division of the National Institutes of Health - released a new set of clinical guidelines for the prevention, detection and treatment of high blood pressure.

Concurrently published in the Journal of the American Medical Association, the seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (often referred to as the JNC7) reflects the first significant revisions since 1997.

Among the guideline's revisions:

--A new pre-hypertension level - ranging from a blood pressure reading of 120-139 over 80-89 - targeting people who are risk for the condition. Drug treatment is not recommended for those who meet the pre-hypertension category, but the guidelines recommend lifestyle changes - such as a healthy diet, physical activity and quitting smoking.

It's the pre-hypertension element that will generate a lot of discussion among health-are professionals, says Emrani.

``We are now in the era of pre-disease. Somebody can be pre-diabetic - and now pre-hypertensive. Pre-hypertension is a warning to the doctor and to the patient as a team that you better get serious about this disease.''

--Stronger drug treatment recommendations, including the use of multiple medications to bring blood pressure to the desired level. Diuretics, the report states, are not being used as often as they should be.

The guidelines also encourage physicians to work with hypertensive patients to develop goals and treatment plans. But again, the patients have to be willing to put in the work to make the changes, even if - despite threatening numbers - they feel otherwise healthy.

``We don't want people to get away with that answer anymore,'' says Dr. Henry R. Black, chairman of the department of preventive medicine at Chicago's Rush University, and part of the executive committee that produced the JNC7 guidelines.

``We're very struck by the so-called lifetime risk of becoming hypertensive,'' he continues. ``If you have normal blood pressure at 55 and you live to be 85, your chances of having elevated blood pressure go up to 90 percent. Unless we get some control over this epidemic before it happens, we're going to get drowned in the complications and costs of elevated blood pressure.''

Blood pressure is pressure put on artery walls by blood as it flows through the arteries. A blood pressure reading is made up of two numbers and is measured in millimeters of mercury (mm Hg). The top number, or systolic pressure, is the force against the artery wall when the heart is beating. The bottom number or diastolic pressure is the force against the artery wall when the heart is at rest (between beats). Both numbers are important.

A person who has a blood pressure of 140 over 90 has a pressure in the artery (aorta) of 140 millimeters of mercury when the heart contracts and pumps the blood and 90 millimeters of mercury of residual blood pressure when the heart is not contracting.

A consistent blood pressure reading of 140 over 90 or higher is considered hypertensive.

The Institute's data indicates that one in four adult Americans - approximately 50 million - is affected by high blood pressure. A national survey reports than 70 percent of Americans with high blood pressure are aware of the condition, 59 percent are receiving treatment, and 34 percent with hypertension have it under control.

In an effort to tackle the growing problem, Kaiser Permanente offers an hourlong free blood pressure screening every Monday, Wednesday and Friday at the HMO's Woodland Hills Medical Center.

But with as many as 30 people strapping on the cuff during any one screening, there isn't much that health education registered nurse J. Lynn Lamka can do beyond conduct a reading, hand out an information sheet and encourage follow-up.

Blood pressure watchers can get more detailed information in Kaiser's free classes on blood pressure management.

Lamka's advice to 81-year-old Helen Gropman, based on her numbers, was sensible and to the point.

``Call my doctor,'' said Gropman of Woodland Hills, whose blood pressure measured at 186 over 89 after a relatively low reading just days before.

Also waiting to get tested was Bob Robbins. The 50-year-old last had his pressure checked six months ago, and while he has no history of high blood pressure, he keeps a close eye on his health.

``It always gives me peace of mind to know my blood pressure is stable,'' said Robbins, who stopped for a blood pressure screening after an eye appointment. ``I do have high cholesterol, so this is something to keep an eye on.''

While it's better to take high numbers seriously, doctors say it's also possible for a person to become obsessed with his or her own blood pressure. So-called ``white coat hypertension'' - where a person's unease over being in a doctor's office spikes his blood pressure numbers - can occur as well.

Black says he relies only on blood pressure data collected in a physician's office. Although there are a variety of store-bought cuffs that allow people to regularly check their own blood pressure, Black believes that greater research is needed to determine what the numbers mean when they're taken in different situations.

``People say, 'I'm 130 over 80 at home, so I'm fine,' but is that comparable to an office reading of 145 over 90? We haven't established when to consider the numbers high and when to consider them low,'' he says. ``The conditions change if you've been sitting for a long time, if you become bored by a TV program or if you become over-excited by one.''

At Kaiser, medical center officials have a slightly different perspective, according to Dr. Arleen Rockoff, chief of internal medicine. But that doesn't mean everybody should go out and buy the first cuff that strikes their fancy and start calling their doctors when the numbers don't seem to line up.

``Through our classes, we show them how to check it appropriately, and we encourage them to buy the cuff,'' says Rockoff. ``The vast majority of people can do it very reliably.''

Evan Henerson, [phone]

evan.henerson(at)dailynews.com

Healthy advice

Most of us expect to have our blood pressure checked every time we visit the doctor. For people who are looking to monitor their blood pressure more than once or twice a year, the National Heart, Lung and Blood Institute offers the following suggestions.

When getting your blood pressure checked:

1. Don't drink coffee or smoke cigarettes 30 minutes before having your blood pressure measured.

2. Before the test, sit for five minutes with your back supported and your feet flat on the ground. Rest your arm on a table at the level of your heart.

3. Wear short sleeves so your arm is exposed. Go to the bathroom prior to the reading. A full bladder can change your blood pressure reading.

4. Get two readings, taken at least two minutes apart, and average the results.

5. Ask the doctor or nurse to tell you the blood pressure reading in numbers.

The most common way people test their own blood pressure is with the familiar cuff and stethoscope. A doctor or nurse can give you advice on which brand to buy. They can also test the device and show you how to use it.

For both prevention and treatment of high blood pressure, doctors recommend:

1. Following a healthy eating plan.

2. Reducing salt and sodium in your diet.

3. Maintaining a healthy weight.

4. Quitting smoking.

5. Being physically active.

6. Limiting alcohol intake.

For more information, visit www.nhlbi.nih.gov/hbp

- E.H.

CAPTION(S):

3 photos, box

Photo:

(1 -- color -- cover) How's your blood pressure?

What the numbers say about our health

David Sprague/Staff Photographer

(2 -- 3) Health education registered nurse J. Lynn Lamka encourages patients at Kaiser Permanente in Woodland Hills to follow up with their doctors if their blood pressure is too high.

Phil McCarten/Staff Photographer

Box:

Healthy advice (see text)