As I read the current medical journals, I have to make use of a new “library” of terms that refer to our bodies’ genes, RNA messengers, proteins and enzymes, not to mention the generic names of the drugs meant to impact the molecular basis of disease. But as medical knowledge becomes more “micro,” we can’t discount the macro…the need for individuals to get basic screening, diagnosis and therapy of common disorders. There is no requirement for medical ten-dollar words to understand the recent “Vital Signs” article in JAMA. It was a report by the National Center for Health Statistics at the CDC, documenting the prevalence, treatment and control of hypertension in the United States.  Here are some of the stats that they reported, which could on their own make ones blood pressure go up by at least a few points. (I’m talking systolic here…)

• Every year, hypertension contributes to one out of seven deaths in the U.S. and tonearly half of all cardiovascular disease-related deaths (heart attack and stroke).Hypertension affects an estimated 68 million U.S. adults.
• If all individuals received adequate treatment for their hypertension, 46,000 deaths might be averted each year.
• Direct and indirect costs of hypertension are more than $93.5 billion per year
• Cardiovascular disease and stroke account for 17% of total health expenditures in the US annually
• Overall U.S prevalence of hypertension among adults after the age of 18 between 2005 and 2008 was 30.9% (and highest among persons at or older than 65). This prevalence has remained unchanged during the past 10 years.
• 30% of patients with hypertension are not being treated pharmacologically.
• Only 45.8% of those with hypertension have their blood pressure adequately controlled.

There are, of course, recommendations as to what should be done to deal with this pervasive disorder and the resultant disease. Blood pressure readings should be taken seriously (and regularly). Anyone who has a blood pressure that is 140/90 needs to consider medication and lifestyle changes. Physicians now think that blood pressure reductions below the threshold for clinical hypertension (115/75) can have health benefits over time. An analysis of over 61 prospective observational studies of blood pressure and mortality (you know the ones that follow large groups of individuals for years) have shown that for each 20 mmHG increase in usual systolic blood pressure (This is the top number in blood pressure readings and represents the pressure that your heart is exerting to get the blood to flow through your arteries) or 10mmHG increase in usual diastolic blood pressure (which represents the pressure of the vessels between heart beats) above 115/75 mmHG was associated with a doubling in stroke mortality and death from heart attack at ages 40 to 69.

Before I sound the “get thee medicated” alarm, let’s go over the behavioral changes that can impact blood pressure. They should be adopted by all of us. (I’m sure we all know them, but since the American Heart Association has made them official here they are: (1) achieving and maintaining a healthy body weight; (2) participating in regular leisure-time physical activity (and I don’t think shopping counts, unless you have to walk rapidly for a total of 30 minutes from store to store to car.) (3) adoption of a healthy diet, including reducing salt intake and increasing potassium intake; (4) smoking cessation; and (5) stress management) Note, the AHA gave no indication in this report as to how to do this and I’m not going to begin to tackle stress reduction  in this “brief” newsletter. It would require a treatise in philosophy, psychology, economics and the 24-hour news cycle!

There are, of course, multiple pharmacologic therapies and frequently more than one is needed to achieve adequate blood pressure control. That’s where a physician’s knowledge and choices of medication are needed (as well as health insurance to help pay for access to the physician, appropriate follow-up and purchase of the medications… According to this CDC report, one of the groups with the lowest prevalence of blood pressure control consists of individuals without health insurance.)

Molecular biology may help us understand the whys, wherefores and potential treatments of disease. But unless we self-maintain our own health by eating right, moving our derrieres off the chair (I guess you should get off your computer, iPad or Blackberry where you are currently reading this admonition), adhere to prescribed medication and improve access to care, that “one in seven” (deaths due to hypertension) will continue.

Bottom line: Make sure your blood pressure is checked regularly and if elevated, even “a bit” (over 115/75) work on your lifestyle. If 140/90 or over, check with your physician as to your need for medication and adhere to whatever is prescribed. The pressures of life (and death) start with your own!

I know we have all heard the admonitions not to text or use hand-held cell phones while driving. Oprah even wrote an editorial in the New York Times. I installed a hands free device in my car several years ago in order to comply with California laws as well as to assume my role in assuring road safety to those in my car (mostly my dog) as well as on the road. A commentary in the April 15th issue of JAMA caught my attention and pointed out my inattention to the statistics that warn that even hands free devices result in accidents.

So here are the distracting statistics:

• 5,870 persons died (16% of all fatalities) in crashes involving driver distraction due to texting or use of mobile phones in 2009
• 515,000 individuals were injured in what are now called “distracted crashes”.
• 21% of all reported injury crashes involved distracted driving
• While dialing a mobile phone, drivers of light vehicles (cars, vans and pickup trucks) were 2.8 times more likely to crash or near crash than non-distracted drivers. (If they were commercial truck drivers this number rose to 5.9.)
• Texting is a disaster waiting to happen….the average person who texts while driving takes her eyes off the road for 4.6 to 6 seconds and is 23.2 times as likely to have a serious vehicular crash compared to a non-texting driver.

And here is what really got my attention:

Analysis of 125 studies confirmed that cell phone conversations while driving were associated with impaired reaction time and that there was NO difference in risk between hands-free and handheld phones! And according to the Highway Loss Data Institute (yes there is an institute for everything) the benefits of banning the use of hand-free phones are outweighed by the increased use of similarly distracting hands-free devices. They found no decrease in crashes in states that enacted handheld cellular phone bans when compared to states that did not.

As I and my family update our cars, we are bestowed with more and more electronic gadgets. I can now do everything but write this column while driving… but I guess I won’t try. The good news is that using a GPS (with verbal instructions) is safer than trying to read a map. So I can tell my husband (who always gets lost) that his GPS is relatively safe. But the bad news is that I will not try to save time and answer patient queries while driving but instead will instruct you to call back once I have reached my destination.

Our cars should be declared no phone or messaging zones. For your sake, mine and all the other drivers and pedestrians on the road, I hope you will consider the above stats and turn your i-phones, blackberries, droids and i-pads off while driving.

I know this isn’t a gynecologic subject, but it does allow us to tell our spouses, adult children, friends (and ourselves) to slow down, be alert and use a seat belt….and  for goodness sake stop talking on that handheld or even Bluetooth connected phone while driving. In 2005 (the most recent year for which data are available) 45,520 deaths in the United States were related to motor vehicle accidents. I wish I could  prominently display this number on my window every time I see a driver talking on their phone, turning to the back seat to talk to children or other passengers or (and this could be generically female) putting on make-up while driving!