Although the death rate for high blood pressure has declined in the United States in recent years, a newly completed report shows that the rate in Los Angeles County is 53% higher than the national average and that the gap appears to be increasing.
The explanation for the higher risk is not known, said Dr. Morton Maxwell, chairman of the American Heart Assn.'s high blood pressure planning committee for greater Los Angeles.
Maxwell speculated, however, that "an emphasis on holistic medicine that has backfired" may be contributing to the county's higher risk.
"We may have a lot more health conscious people than is standard for U.S. cities," he said Tuesday. "Most things start here and move east. There are a lot of people who think they can control their blood pressure by themselves by reducing salt intake, diet, biofeedback or meditation.
"Those methods do work on some individuals," Maxwell said, "but they work sporadically. Most need drugs to bring the pressure down.
"I don't believe in the approach that says, 'Don't go to a doctor, you can cure yourself.' Exercise and diet don't cure everything."
The Los Angeles study was completed last year by epidemiologists at the UCLA School of Public Health. It is the county's most detailed look at cardiovascular disease, of which high blood pressure is an important entity.
"Very few other counties have done this kind of study," Maxwell said. "There may be a lot of pockets in the U.S. in which the rate for high blood pressure is higher than the national average. It would be a lot more informative if we had New York, Atlanta and Chicago to compare and see whether the same thing is going on elsewhere."
The Los Angeles study, conducted between 1979 and 1981, established that the death rate from hypertensive disease in the last year of the study was 20.3 deaths per 100,000 population, compared to 13.3 per 100,000 for the United States as a whole--a rate about 53% higher.
Although it is well established that blacks are at higher risk for hypertension than either whites or Latinos, the death rates for all three groups, plus the Chinese population, were above the national average. The rates were 18.7 deaths per 100,000 population for whites, 47.7 for blacks, 19.9 for Latinos and 17.1 for Chinese.
Among other Asian-Americans, the rate for Japanese was 11.6 and 3.2 for Koreans.
The study also indicated that deaths from hypertensive disease are continuing to rise in the county. The 1981 rate of 20.3 per 100,000 was 19% higher than the 1980 rate of 17 per 100,000. In 1981, there were 1,535 deaths directly attributable to hypertension in Los Angeles County.
In addition, hypertension is the single most important risk factor for dying prematurely from stroke or a heart attack. It was, therefore, an important contribution to the 30,000 deaths in the county from heart and kidney diseases and stroke in 1981.
Maxwell said the study findings are puzzling, considering that another survey by the state Department of Health Services showed that the public's general awareness of hypertension has increased greatly over the last few years.
An important part in public education is that virtually all cases of hypertension can be controlled with the correct dosage of anti-hypertensive drugs.
Yet, the survey revealed, only about 6 people out of 10 who have high blood pressure are aware of it, only half of them are taking drugs and fewer than 1 in 5 of these individuals has the disease under good control.
"The public has learned a great deal, but many are not complying," Maxwell said.
A key problem, the physician said, is that hypertension produces no symptoms. The individual must have his blood pressure taken before he can be aware that it may be high. Also, he said, concern about drug side effects tend to make some individuals--especially males who fear impotency from the medication--stop taking the drug or reduce the dosage below the needed level.
Maxwell noted, however, that a great many new drugs have come on the market, so that the doctor can change drugs until one is found that causes no side effects.
According to the latest American Heart Assn. guidelines, a reading of 140/90 or higher is now regarded as high blood pressure. The higher the reading above that level, the greater the risk of premature death, Maxwell said.