How High Is High?

High blood pressure, by itself, is not a disease and never killed anybody. Even in its commonest disease form, which doctors call "essential hypertension," damage to the kidneys and other organs is the result of changes in the small arteries, not of the high blood pressure. Yet countless people start worrying themselves sick when they are told they have a high reading.

Well aware of such laymen's worries, Dr. Arthur M. Master of Manhattan's Mount Sinai Hospital and Dr. Louis I. Dublin of the Metropolitan Life Insurance Co. asked themselves: How high is high blood pressure? To get the answer, they had to find out what is normal blood pressure--an item that a generation of researchers had failed to agree on. Dr. Dublin, aided by Statistician Herbert H. Marks, culled the health records of World War II workers at air bases and war plants, tabulated the blood pressure of 15,706 seemingly normal, healthy men & women from 16 to 65. They found a much greater range than had previously been considered normal. Therefore, they concluded, the definition of "normal" should be revised to fit the facts.

Physicians and insurance statisticians have made the mistake of looking too hard at the mortality tables, say the three authors in the Journal of the American Medical Association. The tables show more deaths among people whose blood pressure exceeds 140 mm. systolic and 90 mm. diastolic.* This fact is meaningless, they argue, because blood pressure usually increases naturally with age. So the thing to do is forget about an "ideal" reading, start with healthy people and accept their readings as normal.

From what they found to be normal in practice, Master, Dublin and Marks suggest these ranges as normal:

MEN WOMEN Age Systolic Diastolic Systolic Diastolic 20 105-140 62-88 100-130 60-85 30 110-145 68-92 102-135 60-88 40 110-150 70-94 105-150 65-92 50 115-160 70-98 110-165 70-100 60 115-170 70-100 115-175 70-100

On each side of the normal ranges, the authors think, there should be a twilight zone (usually five to ten points wide). In this zone, blood pressure would be looked on with suspicion and carefully rechecked, but still with no conclusion that the patient had "high" or "low" blood pressure. Such a worrisome diagnosis would not be made, they suggest, until there was a clearly abnormal level, e.g., low blood pressure for a man of 20 would be 98/56 or less, while high blood pressure would be 150/95 or more. At 40, low would begin at 102/60, and high would begin at 165/100. (For younger women the norms are slightly lower; for older women, some are slightly higher.)

Release from worry is the first thing prescribed by most doctors for patients with high blood pressure. The tables of Master, Dublin and Marks may be just the thing to help such patients stop worrying--or worry less.

*The pressure of the blood on the walls of the arteries is measured by the height of the column of mercury it will support. The systolic reading is maximum pressure, the diastolic, minimum. The two readings are written 140/90 and spoken of as "140 over 90."

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