Roughly a week before Thanksgiving in 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for what constitutes high blood pressure, or hypertension, effectively putting 46 percent of Americans above the threshold for what is considered safe.
If these guidelines were applied to Barbadians, only 1 in 3 Barbadian adults, or 33 percent of the population, were considered to have high blood pressure, which was defined as a blood pressure reading of 140/90 mmHg (millimeters of mercury). The new guidelines define high blood pressure as 130/80 mmHg.
These new guidelines, which appeared in an article published in November 2017 in the Journal of the American College of Cardiology, were developed with nine other health professional organizations to hopefully more accurately identify those at risk for serious health issues.
“One good thing about the new guidelines is that they remind people that high blood pressure is a major risk factor for premature heart disease, stroke, heart attacks, heart failure, and even dementia,” says William Frishman, MD, chair of medicine at New York Medical College and director of medicine at Westchester Medical Center in Valhalla, New York. “By following the new guidelines, we’ll see fewer negative health outcomes from high blood pressure.”
What Is Blood Pressure and What Do The Numbers Mean?
Blood pressure is the force of your blood pushing against the walls of your arteries each time your heart beats. The first number in a blood pressure reading represents the force exerted when your heart contracts. This is called systolic pressure. The second number, diastolic pressure, measures the force exerted between beats. Elevated systolic blood pressure has been shown to be a better predictor of cardiovascular disease risk than diastolic blood pressure, according to research published in March 2014 in The American Journal of Medicine.
Under the new guidelines, blood pressure categories are now defined as follows:
- Normal: Less than 120/80 mmHg
- Elevated: Systolic between 120 and 129 and diastolic less than 80
- Stage 1 hypertension: Systolic between 130 and 139 or diastolic between 80 and 89
- Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mmHg
- Hypertensive crisis: Systolic over 180 or diastolic over 120, which requires prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
Will the New Guidelines Put More People on Medication?
Not necessarily. But before any discussions about medication occur, it’s important to confirm that you actually have high blood pressure. Your blood pressure fluctuates throughout the day, especially when you’re active or nervous. For example, it’s common for patients to have elevated blood pressure readings in their doctor’s office. This is referred to as white coat hypertension.
“Patients should have their blood pressures measured in different ways than in the past,” says Mary Ann Forciea, MD, chair of the clinical guidelines committee for the American College of Physicians. “The standard should be measurement by an electronic machine after five quiet minutes in the examination room, not on arrival at the practice. Alternatively, some patients may have their blood pressures measured over a period of 24 hours with a specialized home monitor, or keep logs of home measured blood pressure.”
If you have systolic blood pressure between 120 and 129, Dr. Frishman recommends to change some of your health behaviors, like weight management and eating better.
If your systolic blood pressure is between 130 and 139 and you already have heart disease or are at increased risk for heart disease, your doctor may consider treating your high blood pressure with medication.
For people with relatively uncomplicated high blood pressure, your doctor may wait until it reaches 140 or above to treat. In many cases, the goal will be to treat the blood pressure to 120 or below with lifestyle changes and medication when appropriate.
It’s important to remember that under the new guidelines, only a small increase in the number of adults requiring antihypertensive drugs is expected. If you do need medication, the good news is that all the drugs for blood pressure are generic and relatively inexpensive. They’re also well tolerated by most patients.
Role of Lifestyle Change in Managing Blood Pressure
The new guidelines also highlight non-pharmacological approaches for lowering blood pressure, including:
- Weight loss for those who are overweight and obese
- A healthy diet
- Sodium reduction
- Increased physical activity
Limited alcohol consumption. For example, it’s recommended that men have no more than two drinks daily, and that women have no more than one drink daily, since alcohol can raise your blood pressure.
Weight management in particular is very important, notes Frishman, but changes don’t have to be extreme. For example, if a person is 30 or 40 pounds (lbs) overweight, even losing 5 to 10 lbs can be enough to help bring their blood pressure down. Modest changes in weight can also reduce your risk of developing diabetes.
What Do the Guidelines Mean for Older Adults? One criticism of the new guidelines is how to best treat older adults with high blood pressure. For example, if an older person’s systolic blood pressure is over 170, trying to get it down to 120 can be very challenging. In this scenario, lowering the blood pressure to 150 or even 145 can still have benefits, notes Frishman.
In January 2017, the American College of Physicians and the American Academy of Family Medicine announced a guideline on blood pressure targets for people 60 and older that appeared in an article published in March 2017 in the journal Annals of Internal Medicine. They recommended that physicians initiate treatment when persistent systolic blood pressure is at or above 150 mmHg, to achieve a target systolic blood pressure of less than 150 mmHg, because high-quality evidence shows that it reduces the risk of mortality, stroke, and cardiac events.
“All experts agree that reducing blood pressure to levels of 150/90 in all patients is beneficial. Almost all agree that in some patients reducing further has benefit. If you can’t achieve that goal through weight loss, diet, and exercise you will benefit from a conversation with your physician about what medications are best for you, and what target blood pressure best meets your needs,” says Dr. Forciea.
But even with the new guidelines, treatment must be individualized.
“Physicians will be trying to give the best advice possible for each patient. What blood pressure target is best for an individual will depend on many factors: their history of diabetes, heart disease, or stroke, coexisting illnesses, and their own personal goals about lifestyle management and medication use,” says Forciea. “What’s best for a patient in one exam room may not be best for the patient in the next room.”
It’s important to have open communication with your doctor and to practice shared decision making. That’s when you work together with your doctor to make health decisions and to create a plan of action that’s right for you.
BETTER HEALTH & BEYOND Editorial Team
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