Michael Robinson, 35, is young enough to remember his glory days playing college basketball, which was one reason he was so surprised when just walking to his car started to wear him out. Robinson's weight certainly didn't help: 345 lbs. is a load to carry, even on a 6-ft. 9-in. frame. His family history worked against him too. Both his parents have high blood pressure, and his father and brother are diabetic. And he didn't do himself any favors by allowing seven years to elapse since his last checkup. When his persistent fatigue finally drove him to a doctor, he learned the wages of so much neglect. His blood pressure was topping out at a monitor-popping 166/120, and he was in the early stages of heart failure.
A year later, the Ashburn, Va., man exercises regularly, takes hypertension medication, and has dropped his fast-food burger habit in favor of low-fat grilled chicken. He has a lower-stress job with the county department of family services and is the father of a new baby boy. "I'd like to be around for him," he says. His new blood pressure should help. It's 120/80.
Robinson's turnaround was impressive, but according to the experts, such stories are increasingly rare. At least 65 million Americans--a third of all adults over 18--are thought to suffer from hypertension (the technical term for persistent
high blood pressure), up from 50 million just 10 years ago. Worse, doctors last year defined a new category of risk, prehypertension, in a borderline pressure range that is now considered a bright red flag of trouble to come. Moreover, when people do address their blood-pressure issues, they don't always do it very well. Only about a third of all patients in treatment for high blood pressure have their numbers under control. Over the course of our lives, perhaps 90% us will develop a blood-pressure problem, and at least half of us will die from either heart disease or stroke--hypertension's frequent endgames.
Alarmingly, it's not just middle-agers and seniors who are turning up with the problem. So are kids. Dr. Keith Ferdinand treats patients in a community health clinic in one of the poorest neighborhoods in New Orleans and has lately been shocked to see more and more young patients coming in with elevated pressure. Four years ago, he treated his first 18-year-old heart-attack victim. "We're seeing not only a growing number of cases of hypertension in young people," he says. "We're also seeing a growing number of complications from it."
The blood-pressure problem was never supposed to get this far. Not all that long ago, the battle against hypertension was touted as one of the U.S.'s great public-health success stories. Almost absurdly easy to detect--a few painless seconds with a pressure cuff does it--hypertension is comparatively simple to treat with weight loss, lifestyle changes and a little medication. In the 1970s, doctors began tackling the condition aggressively, and as the percentage of people being treated crept up, the incidence of hypertension-related conditions fell. Strokes alone declined more than 50% from 1972 to 1994. Clearly, the country was closing in on a big medical win--with medications like beta blockers and angiotensin-converting enzyme (ACE) inhibitors making big contributions to that success. But the ball has been dropped, and the reasons, in retrospect, are clear.