Blowing A Gasket

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In the cause-and-effect universe of epidemiology, societies get the blood pressure they deserve, and we Americans have earned ourselves some huge problems. We are heavier than we have ever been, with 65% either overweight or obeseincluding 15% of kids. We're lazy too. Only 24% of us exercise vigorously at least three times a week. We smoke too much (22% of adults still light up), drink too much, and with our fetish for fast and processed foods, we're practically pickling ourselves with salt.

Worse, demographics ensure that the hypertensive population is only going to grow. As the bow wave of the baby-boom generation prepares to hit 60, more than 77 million of us will begin entering our golden--and most pressure-prone--years. Following the boomers will be their kids and grandkids, with up to 3% of the juvenile population thought to be hypertensive. "More than 25% of children with high blood pressure may already have some cardiac thickening," says Dr. Bonita Falkner, a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia.

In the face of those grim numbers, the medical and pharmacological communities are scrambling. Drug companies are rolling out new medications to join the arsenal of blood-pressure drugs already on the shelves. Physicians are routinely checking pressure in younger and younger patients. Public-health officials are launching new information campaigns, trying to raise public awareness in the hope of getting to the at-risk population before it's too late. Such large-scale mobilization may be the only way to get the problem back in check. "There's good evidence hypertension can be controlled," says Dr. Darwin Labarthe, acting chief of cardiovascular health at the Centers for Disease Control and Prevention (CDC), "but it will take an intense, sustained effort."

BREAKING DOWN

One reason hypertension can be such a stubborn problem is that it involves so many of the body's interlocking systems, and lying at the center of it all is the heart. The heart doesn't so much pour blood through the circulatory system as punch it through, forcing six quarts of heavy liquid beyond the torso and out to remote provinces like the feet, hands and head. Unfortunately, the riptides of the circulatory system are not always kind to the vessels that have to carry the load. Every time the heart contracts, blood not only rushes ahead through the vessels but also presses against the walls. That pulse is the systolic pressure, the first number in your blood-pressure reading. When the heart relaxes between beats, the pressure eases too but only to a point. That is the diastolic pressure, the second number. The force of both pressures is measured by how high a pulsing artery can push a column of mercury in a blood-pressure monitor. In general, 120 mm during a beat and 80 mm between beats are considered normal.