Blowing A Gasket

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The newest and most surprising at-risk population, however, is the kids, a group in which hypertension, until recently, could not even be uniformly diagnosed. Optimum blood pressure changes with age and body size, and what's right for an adult is wrong for a preteen, to say nothing of a baby. A 2-year-old girl in the 50th percentile for height may have an average blood pressure of just 88/45. That same girl at age 10 should be up to 102/60, still far below the traditional adult benchmark of 120/80. The NHLBI now recommends making blood-pressure readings a part of all visits to the pediatrician. Any child who repeatedly scores in the 95th percentile or above for height, age and sex should be considered in danger.

FIXING WHAT'S BROKEN

What to do when any patient--child or adult--has hypertension varies from case to case, but some steps are obvious. Smoking, which is potentially lethal for everyone, is poison for the hypertensive. Tobacco accelerates heart rate and constricts blood vessels, just what you want to do if you're trying to make a hypertension problem worse but a lousy idea if you want to get well.

Controlling weight is also vital. The body tunes and retunes a lot of dials to keep its blood pressure balanced, and obesity twists those knobs in all the wrong ways. For one thing, increased body mass means higher blood volume, straining the circulatory system. Carrying extra weight also causes the heart to overwork--no favor to a left ventricle that may already be enlarged. Additionally, people who are overweight generally don't get that way eating fruits, vegetables and lean meats; their diet tends to be high in salt, fats and processed foods, just the things hypertension feasts on.

Another variable is not just how much weight you're carrying but where you're carrying it. Most of our swaddling of fat is located under the skin and over the muscle, but around the abdomen there is another layer beneath the muscles. This so-called visceral fat produces inflammatory molecules that lead to insulin resistance and diabetes. The same molecules also destroy nitric oxide, which is critical to the ability of the blood vessels to relax. "Central fat is a linchpin in the abnormalities that lead to hypertension," says Dr. James Sowers of the Downstate Medical Center in New York City.

If an overweight or otherwise out-of-shape person is lucky enough to have mere prehypertension, the condition can often be controlled with diet and exercise. "If someone comes to me with prehypertension," says Bakris, "I pull out my pad and write a lifestyle prescription first."