Do we all have high blood pressure now? An explanation of new guidelines

About 13 million Americans were estimated to be unknowingly living with high blood pressure. Now, with the release of the American College of Cardiology/American Heart Association blood pressure guidelines in November 2017 – which described new, lower blood pressures goals – even more adults are considered to have this condition.

Under the new guidelines, 46 percent of U.S. adults now have high blood pressure, compared with 32 percent (or approximately one in three adults) under the prior guidelines. Two percent of adults are newly recommended for blood pressure-reducing medications, and for those already taking high blood pressure medications, 14 percent are recommended to add new medications or increase their doses to meet the new blood pressure targets. That sounds like a lot. So why the change? And what can we do about it?

No matter how you define it, high blood pressure, also known as hypertension, is a condition that affects many millions of Americans. It’s the most common chronic condition that affects older adults. Many people believe they might feel lightheaded or dizzy if their blood pressure is high, but this often isn’t the case. Your blood pressure can change from moment to moment based on the situation.

Stressful situations, like visiting the doctor, can certainly raise your blood pressure temporarily. Nevertheless, blood pressure isn’t just related to stress. Being overweight or obese, leading a sedentary lifestyle and eating excess salt in your diet can also lead to high blood pressure over time.

Hypertension is called a silent killer because people usually have no symptoms when their blood pressure is high and don’t see their doctor because they feel fine. Yet hypertension is one of the most common risk factors for heart disease and stroke, and appropriate prevention and treatment is crucial.

Your blood pressure consists of two numbers: systolic over diastolic blood pressure. The systolic blood pressure is the higher number, indicating the pressure of the heart pumping blood to the rest of the body. The diastolic blood pressure is the lower number, when the heart is relaxing, getting ready for the next heartbeat.

[See: 17 Ways Heart Health Varies in Women and Men.]

SPRINTing to New Guidelines

Based on large studies of the population, it’s become evident that the higher your blood pressure is, the higher your risk of heart attack, stroke and heart failure. There’s generally a linear relationship, with risk of heart disease and stroke rising steadily when blood pressures are higher than 115 millimeters of mercury systolic and above 75 millimeters of mercury diastolic. A large clinical trial called SPRINT, which was published in the New England Journal of Medicine, found that participants with other heart disease risk factors had fewer heart attacks and strokes when they were treated to achieve a blood pressure goal of systolic 120 millimeters of mercury rather than a less stringent goal of 140.

These studies, along with other smaller studies demonstrating similar results, led the ACC and AHA to publish the new guidelines. A normal blood pressure is considered less than 120/80 millimeters of mercury. Blood pressures of 120 to 129 millimeters of mercury systolic are now defined as “elevated.” Blood pressures greater than or equal to 130 millimeters of mercury systolic or 80 millimeters of mercury diastolic are now considered hypertensive. Previous guidelines had a threshold for hypertension of 140/90.

The goal of the new guidelines is to prevent heart attacks and strokes in adults. They emphasize changes in lifestyle habits in order to prevent and treat hypertension. In addition, the guidelines specify that if you’re hypertensive but have a low overall risk of cardiovascular disease in the next 10 years, with a systolic blood pressure of 130 to 139 and/or diastolic of 80 to 90 (stage 1 hypertension), it’s recommended that you work on lifestyle changes rather than take a medication.

For patients with established cardiovascular disease or at high risk for cardiovascular disease as determined by various cardiovascular risk factors (with an estimated 10-year risk for a heart attack or stroke that is equal to or greater than 10 percent), drug therapy in addition to lifestyle changes are recommended for those with 130 to 139 millimeters of mercury systolic or 80 to 89 millimeters of mercury diastolic. And for everyone else, drug treatment is recommended if blood pressure is consistently above 140 systolic or 90 diastolic (stage 2 hypertension). The new guidelines emphasize that these treatment decisions should be made based on accurate blood pressure readings obtained with proper technique and from readings from more than two occasions.

Some physicians are concerned about the new guidelines and are worried that by striving to reduce blood pressures to less than 130/80, more people will have side effects from their antihypertensive medications. All antihypertensive medications can cause lightheadedness or dizziness, and physicians are concerned older individuals could be at risk of falls or fainting. Fortunately, clinical trials haven’t shown any conclusive evidence that this is the case. Higher doses of antihypertensive medications may be needed to achieve these more stringent goals; a patient’s medication list should be carefully reviewed by his or her health care provider for potential medication interactions.

[See: 10 Heart Health Breakthroughs.]

Lifestyle Changes Are Key

So what are effective ways to reduce blood pressure without medication? There are several ways proven to lower blood pressure: a healthy, low-salt diet, regular exercise, weight loss, reduced alcohol intake if drinking more than one to two drinks daily and smoking cessation.

Your provider might recommend a plant-based, healthy vegetarian diet, a DASH diet or a Mediterranean-style diet — all have shown benefit in lowering risks of heart disease. Fruits and vegetables, a key component of all three diets, are lower in sodium (salt) and higher in potassium, which can help keep blood pressure in check. Excess salt in the diet increases blood pressure, particularly in those who have a genetic predisposition to hypertension.

Many people eat more salt than they are aware of. Some foods are obviously salty, such as chips and pickles, but many foods have hidden salt. Most canned and frozen foods use salt to keep them preserved. For example, cheeses or processed meats such as deli meats, prosciutto or salami have a great deal of salt even if they don’t taste salty. Most restaurants add salt to food to make it taste better, so cooking at home is generally healthier where you can control how much salt you add to food. If you use frozen or canned vegetables, for example, you can reduce the salt just by rinsing them before cooking.

The DASH diet, or Dietary Approaches to Stop Hypertension, involves limiting salt consumption to less than 2 grams daily. The Mediterranean-style diet encourages consumption of fruits, vegetables, olive oil, nuts, whole grains, legumes, fish and lean meats such as chicken. Sweets and butter or lard should be very limited.

Vegetarian diets tend to incorporate more fiber, are lower in unhealthy fat and are founded on fruits and vegetables. A study published in JAMA Internal Medicine, which combined the results from 32 smaller studies, found that vegetarians had an average 7 millimeters of mercury systolic and 5 millimeters of mercury diastolic lower blood pressures compared to meat-eating individuals.

Exercise (brisk physical activity) can also improve blood pressure. Both aerobic exercise such as jogging or bicycling or high intensity interval workouts can improve blood pressure. The AHA recommends exercising for at least 30 minutes, five days a week to maintain a healthy heart.

Weight loss, particularly if you are overweight or obese, is another proven means to improve your blood pressure. Every 2.2 pounds (1 kilogram) of weight loss is estimated to lower your systolic blood pressure by 1 millimeter of mercury, on average. So if your blood pressure starts at 137 millimeters of mercury, and you lose 11 pounds, your systolic blood pressure would likely decrease to around 132 millimeters of mercury.

If one drinks alcohol it should be in moderation only — no more than two drinks per day for men and one drink per day for women, as higher intakes can contribute to increased blood pressure and other health problems such as liver disease, irregular heartbeat or risk for car accidents.

Finally, quitting smoking is the best thing you can do for your health. Although cigarettes help people feel more relaxed for a few minutes, smoking increases your blood pressure over time. Smoking over the long term stiffens your blood vessels and accelerates the buildup of cholesterol and plaque in the arteries, dramatically increasing your risk of heart attacks and strokes.

There are many other herbal remedies that you may see advertised or described such as garlic, Coenzyme Q10, apple cider vinegar or turmeric, for example, that tout blood pressure-lowering properties. Supplements aren’t regulated by the Food and Drug Administration like prescription medications are, therefore herbs or vitamins aren’t always what they claim to be. There isn’t any evidence that herbal supplements are effective in lowering your blood pressure, so speak with your physician before starting any new medication or supplement.

[See: The Best Foods for Lowering Your Blood Pressure.]

Take-Home Tips

— It’s important to measure blood pressure accurately. You should be resting for five minutes with your feet on the floor, have an empty bladder and no caffeine for 30 minutes prior to reading. Measure your blood pressure with your arm resting comfortably supported at heart height (such as resting arm on a table).

— If a new diagnosis of hypertension is made in the clinic but not felt to be accurate, your doctor should consider the use of home blood pressure monitoring to exclude “white-coat” or falsely elevated blood pressure.

— For lower risk individuals with blood pressures in the range of 130 to 139/80 to 89, lifestyle changes alone may be sufficient for management. However, medications are recommended once blood pressure consistently exceeds 140 millimeters of mercury systolic or 90 millimeters of mercury diastolic.

— For higher risk patients, such as those with cardiovascular disease or at high risk for cardiovascular disease, those who have diabetes or chronic kidney disease, medication is recommended for blood pressures equal to or exceeding 130/80.

— For those already taking hypertensive medications, the new target blood pressure is less than 130/80.

— Everyone should follow key lifestyle adjustments, which include eating a healthy low-salt diet rich in fruits and vegetables, exercising, losing weight, reducing alcohol intake and quitting smoking. These changes can improve your blood pressure and help prevent a heart attack or stroke.

More from U.S. News

How to Avoid a Second Heart Attack

10 Heart Health Breakthroughs

6 Drugs That Can Worsen or Increase Risk for Heart Failure

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