The human heart is an amazing organ. If you live for 80 years with an average 80 heartbeats per minute, your heart will have contracted over 3.3 billion times. At an average output of 5L/min, it will have pumped over 210 million liters of blood. Assuming proper function, the main determinant to how hard the heart works is resistance to the outflow of blood. Our common measure of that resistance is called blood pressure.
On November 13, the American College of Cardiology and the American Heart Association released the 2017 Guideline for High Blood Pressure in Adults. Table 1 is an estimate of the percent of the US population that will be classified as hypertensive with the new guidelines compared to the prior guidelines.
Table 1 - Estimated Percentage of the US Population Affected by the New Hypertension Guidelines
| | SBP/DBP ≥130/80 mm Hg or Self-Reported Antihypertensive Medication (2017) | SBP/DBP ≥140/90 mm Hg or Self-Reported Antihypertensive Medication (2003) |
| Overall percentage | 46% | 32% |
| Overall, age-sex adjusted percentage | Men (n=4717)
48% | Women (n=4906)
43% | Men (n=4717)
31% | Women (n=4906)
32% |
| Age group, y |
| 20-44 | 30% | 19% | 11% | 10% |
| 45-54 | 50% | 44% | 33% | 27% |
| 55-64 | 70% | 63% | 53% | 52% |
| 65-74 | 77% | 75% | 64% | 63% |
| 75+ | 79% | 85% | 71% | 78% |
In one study of the US population 25% of cardiovascular events were attributed to hypertension. Other studies have indicated that a 20 mm Hg rise in systolic blood pressure and a 10 mm Hg rise in diastolic BP are each associated with a doubling of the risk of death from heart disease, stroke and other vascular diseases.
And a study from Scotland indicated that 37% of the improvement in heart disease deaths prevented or postponed between 2000 and 2010 was due to lowering of systolic BP. Hopefully, the overall effect of these new guidelines will be a future improvement in the
incidence and mortality rates due to cardiovascular disease.
Speaking of the heart, in this issue of Housecalls Dr. Kadouch discusses a case of coronary artery fistula. Dr. Rooney presents a skin disorder that appears serious but is usually self-limited. And Dr. Rosace has an EKG Puzzler for your consideration.
This is our final issue for 2017, and all of the staff at SCOR wish you and yours a safe and happy holiday.
