Blood & Pressures

What causes high blood pressure? When 850 experts on the subject got together in Manhattan last week at a New York Heart Association conference, they had to admit that 95 times out of 100 they do not know. There were other gaps, almost as great, in their knowledge of how the disease develops and how best to treat it. Columbia University's famed Specialist George A. Perera told, with refreshing frankness, what has been learned. To some laymen, but not to all, what he had to say was reassuring.

One trouble, said Dr. Perera, is that in 20,000 scientific articles over the past 60 years, primary hypertension* has been tied to no fewer than 14 different diagnostic criteria or combinations of them. Estimates of its prevalence range from 5% to 25%. Heredity, sex, race, body type, personality, stress, pregnancy, occupation, diet and climate have been listed as all-important--and of little significance in its development. Mortality, among patients followed for ten years, ranges from 12% to 91%. After sifting all this chaff and studying almost 3,000 patients, Dr. Perera said that he has reached these conclusions:

P: High blood pressure is indeed a disease, affecting about 10 million people in the U.S. Handiest diagnostic sign: a diastolic reading consistently above 90.

P: Victims have many common characteristics, and eventually develop organic complications that cut their life expectancy by as much as 20 years.

P: Heredity is vital. "If either mother or father has it, you can bet your boots that at least one of any large family they produce will eventually become hypertensive; and if both parents have it, the majority of their offspring will be afflicted."

P: Personality, stress and diet do not cause the disease, though they may act as triggers for it. Pregnancy and the menopause have little to do with it.

Primary hypertension, said Dr. Perera, is twice as common in women as in men. The women, but not the men, tend to be overweight. The average age at which it can be detected is about 32. And proven cases of onset beyond age 50 are so rare that Dr. Perera concluded: "You have it or you don't, and if you're past 50 and haven't got it, you won't."

* I.e., high blood pressure for which no underlying cause (such as kidney disease) can be found. Commonest alternate name: essential hypertension.

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