Archived research: Hypertension High blood pressure — or hypertension — is a major risk factor for heart disease and the chief risk factor for stroke and heart failure. Hypertension affects about 50 million Americans, or one in four adults. It is a problem because it causes the heart to work harder than it should. Both the heart and the arteries are then prone to injury. Treatment seeks to lower blood pressure to less than 140 mm Hg (millimeters of mercury) systolic and less than 90 mm Hg diastolic for most individuals with hypertension. For those individuals with diabetes and chronic kidney disease, target goals are less than 130 mm Hg systolic and less than 80 mm Hg diastolic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial — more commonly known as ALLHAT — is the largest antihypertensive trial and second largest lipid-lowering trial ever conducted. Funded by the National Heart, Lung, and Blood Institute (NHLBI), this trial lasted from 1994 through 2002 and included more than 50,000 patients, many of whom were older than 65 years of age. The findings, published in the December 18, 2002 issue of the Journal of the American Medical Association, indicate that all of the four of the drugs studied in ALLHAT are effective in lowering blood pressure. Results show, however, that old-fashioned diuretics work best to both lower blood pressure and to prevent stroke and some forms of heart disease, including heart attack and heart failure. The newer drugs studied included a calcium channel blocker, an angiotensin converting enzyme (ACE) inhibitor, and an alpha-adrenergic blocker. While beta-blockers were not specifically studied in ALLHAT, prior trials found it effectively lowers high blood pressure and prevents heart problems and strokes as well. According to Claude Lenfant, MD, president of the World Hypertension League and former director of the NHLBI, this research has shown something that is extremely important from which many people are going to benefit. At the same time, Dr. Lenfant cautions that there are many situations where the old-fashioned medications would not be the best for a particular individual. That individual would benefit from something else instead of, or in addition to, diuretics. He urges that patients discuss these options with their doctors. As indicated in the ALLHAT trials, many different blood pressure medications are effective in treating hypertension. These all work in different ways to help lower pressure. Medications include diuretics to rid the body of excess fluids, beta blockers to reduce heart rate as well as the heart's output of blood, and calcium channel blockers to slow the heart rate and relax blood vessels. Angiotensin converting enzyme (ACE) inhibitors are another class of medications that treat high blood pressure. These drugs interfere with the body's production of angiotensin — a chemical that causes the arterioles to constrict. Angiotensin II receptor blockers actually block the effects of angiotensin. The finding that diuretics were superior to some other classes of medications was driven by benefits in African Americans and Afro-Caribbeans. More studies are likely necessary to differentiate further which medications may be best for stroke prevention by race. In May 2003, as a result of the ALLHAT study, the NHLBI issued new clinical practice guidelines for the prevention, detection, and treatment of high blood pressure. In addition to providing additional information on drugs to treat high blood pressure and cholesterol, the guidelines feature altered blood pressure categories. The new categories include a new "prehypertension" level, which covers about 22 percent of American adults, or about 45 million persons. These recommendations were published in the Journal of the American Medical Association in May 2003. Click here to read more comments from Dr. Lenfant about how to control high blood pressure. The American Heart Association and government sources advise individuals to eat lots of fruits and vegetables as well as fat-free and low-fat dairy products to help control blood pressure. Such diets are rich in protein as well as important minerals such as potassium, calcium, and magnesium. The Mediterranean diet is another diet generally recognized as heart healthy. Dr. Lenfant further urges individuals to stop smoking, to restrict their salt and alcohol intake, to exercise and control their weight, and to try to avoid conditions such as diabetes that can lead to high blood pressure. Patients who experience difficulty in managing high blood pressure with medication, diet, may benefit from learning a new breathing therapy — Breathe with Interactive Music — focused on prolonged exhalation. RESPeRATE is a patented interactive technology, approved by the U.S. Food and Drug Administration in 2002, to be used in addition to medication and other therapies in the treatment of resistant hypertension. Research published in the Journal of Human Hypertension in 2001 reports that patients realized a sustained blood pressure reduction of 14/9 mm Hg within eight weeks of this therapy.   Content on Infoaging is constantly reviewed and updated by leading researchers specializing in the biology of aging and the diseases of aging. For a list of our content experts, click here.