The last time there were major updates to the way doctors identify, classify and treat high blood pressure (also known as hypertension) was 2003. I was a newly minted cardiologist, having just completed my training at Duke University Medical Center. Over the last decade, there has been much debate about how we can better prevent the complications associated with long-standing high blood pressure, and much research has been done. Finally, earlier this month at the annual scientific sessions for the American Heart Association, the long anticipated updated comprehensive guidelines were released.
Hypertension affects nearly 86 million Americans and is directly related to thousands of heart attacks and strokes every single year. Adequate treatment (and prevention) are critical to avoiding these life-threatening complications. Now, with new definitions for hypertension in place, nearly 50 percent of all Americans will be considered to have high blood pressure.
[See: The Best Foods for Lowering Your Blood Pressure.]
What Is High Blood Pressure?
The new guidelines have completely revamped the way both doctors and patients should look at high blood pressure and will have a significant impact on public health in the United States. High blood pressure is often known as the “silent killer” due to the fact that it can be asymptomatic and insidious, yet, after years of non-treatment, patients with high blood pressure can suffer significant cardiovascular injury. High blood pressure puts us at risk for heart attacks, strokes and kidney disease — just to mention a few of the more significant complications of the disease. Blood pressure is measured by using a sphygmomanometer or blood pressure cuff to determine both the systolic (top number) and diastolic (bottom number) pressures.
What Is New About the Guidelines?
In the past, high blood pressure has been defined as a systolic blood pressure of 140 or greater and/or a diastolic blood pressure of 90 or more. The new guidelines have redefined blood pressure cutoffs to much lower numbers. Now, according to the AHA, blood pressure is considered “elevated” if it is 120 to 129 over 80 or less. Blood pressure is considered high and labeled as Stage 1 hypertension if it’s 130 to 139 over 80 to 89. If the blood pressure is 140 or greater over 90 or more, the AHA classifies this as Stage 2 hypertension. A hypertensive crisis (formerly termed hypertensive urgency or hypertensive emergency) — requiring immediate treatment — is now defined as a blood pressure of 180 and/or a diastolic of 120 or more. The guidelines also address many issues surrounding the epidemic of hypertension in the U.S. today, such as life stressors and lower socioeconomic status. The data makes it clear that these external forces, among others, can contribute to the development of high blood pressure and should also be addressed in any treatment plan.
[See: 10 Lessons From Empowered Patients.]
How Do These Guidelines Impact Treatment?
First, more Americans will be considered to have hypertension — some estimate that the numbers will approach 50 percent. The guidelines will have a very positive impact on care because they will force physicians to identify patients and intervene earlier. The new guidelines also were released with brand new treatment recommendations.
1. For those who are defined as having “elevated” blood pressure, lifestyle modification such as diet, exercise, weight loss and salt restriction is recommended.
2. For those patients who are classified as Stage 1 high blood pressure, the guidelines suggest that treatment depends solely on risk. If a person has risk factors for heart disease such as a positive family history, high cholesterol or diabetes, medical therapy with blood pressure medications should be initiated immediately in addition to lifestyle modification. For those with a prior cardiac event such as a heart attack or stroke, medical therapy with blood pressure medications should also be initiated at the time of diagnosis. For an average risk person with Stage 1 hypertension, the guidelines recommend a trial period of lifestyle modification with monitoring and close follow-up with a physician. If lifestyle modification does not produce results and adequate blood pressure control, medications should be initiated.
3. For those with Stage 2 high blood pressure, treatment should include drug therapy from the time of diagnosis. Lifestyle modification should always be a part of any comprehensive therapy for hypertension.
4. Hypertensive crisis can be a medical emergency and should be treated immediately. If you have a hypertensive crisis as defined by the AHA, you should contact your doctor right away or seek care at the nearest emergency treatment facility.
[See: The Facts on Heart Disease.]
What Should You Do if You Suspect You Have High Blood Pressure?
High blood pressure is a common disease and can damage your body and its organs over a long period of time. Many of us will not have symptoms. If you do have symptoms, they may include headache, dizziness and fatigue — just to name a few.
The best way to determine if you have high blood pressure is to see your primary care physician on a regular basis. Almost every single doctor’s visit begins with a nurse checking your vital signs — pulse (heart rate) and blood pressure. If you find out that you have high blood pressure (as diagnosed by your physician) or if you suspect you may have high blood pressure, it’s vital that you measure your blood pressure at home on a daily basis. Most physicians recommend creating a blood pressure log — either in written or digital form — and bringing that log with you to your office visits. In addition, bring your home blood pressure cuff to your next office visit so the nursing staff can calibrate your device by comparing its readings with the one in the doctor’s office. That way, you’ll be sure to get accurate readings at home.
Allowing your physician to see how your blood pressure readings change over time and how the readings vary at different times of the day can help them better prescribe medications and develop your most effective comprehensive treatment plan. Blood pressure is very treatable. While not everyone needs to take medication in order to treat the disease, many will have to. It’s important to keep your medication list handy and to take all of your medications as prescribed. If you’re having any side effects or suspect a particular medication isn’t working, it’s important to make your doctor aware during your office visit. Most importantly, it’s vital that those with high blood pressure work diligently to maintain a healthy body weight through diet and exercise. There are many cases where losing weight and improving your overall fitness can result in the discontinuation of one or all of your medications for the treatment of hypertension.
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New Blood Pressure Guidelines: What Every American Should Know originally appeared on usnews.com
