Howard LeWine, M.D.

New guidelines published for managing high blood pressure

When it comes to your “health numbers,” your two blood pressure values are important to know—and keep under control. New guidelines for managing high blood pressure in adults, released this morning in a report in JAMA, aim to help doctors know when to start treating high blood pressure and how best to do it.

Millions of Americans have high blood pressure, also known as hypertension. It is the most common risk factor for heart attack and stroke. High blood pressure can also lead to kidney failure, aneurysm (weakening or bulging of blood vessel walls), damaged blood vessels in the eyes, and vascular dementia (the second leading cause of memory loss and thinking problems). Unfortunately, barely half of Americans with high blood pressure have it under control.

First, some background information. Blood pressure is the force exerted on the arteries by a wave of blood propelled from the heart. It is given as two numbers, each measurement recorded in millimeters of mercury (mm Hg), like 122/78. Systolic pressure (the top number of a blood pressure reading) gauges the pressure in the arteries at systole (SIS-tuh-lee), the instant when the heart contracts and pushes a wave of blood along the arterial tree (think “s” for squeeze). Diastolic pressure (the bottom number of a blood pressure reading) is the pressure during diastole (die-AS-tuh-lee), the brief period of relaxation between beats.

What the new guidelines fail to specify is what is “normal” blood pressure and what is high blood pressure. I’m going to stick with the current standard definitions:

  • Normal (meaning healthy) blood pressure: a systolic pressure under 120 and a diastolic pressure under 80.
  • Hypertension, or high blood pressure: a systolic pressure of 140 or higher and/or a diastolic pressure of 90 or higher.

What’s new

In a nutshell, here is what the new guidelines recommend:

  • among adults age 60 and older with high blood pressure, aim for a target blood pressure under 150/90.
  • among adults age 30 to 59 with high blood pressure, aim for a target blood pressure under 140/90
  • among adults with diabetes or chronic kidney disease, aim for a target blood pressure under 140/90.

The expert panel that put together the guidelines also weighed in on how best to get to these targets. It recommended that everyone with high blood pressure, as well as those in the gray zone between normal and high blood pressure, adopt healthy lifestyle changes known to control blood pressure. These include losing weight if necessary, limiting salt intake, eating a diet rich in fruits, vegetables, and whole grains, and keeping physically active.

When drug therapy is needed, the guidelines recommend starting with slightly different medications depending on race. For nonblacks, including those with diabetes, it’s okay to start with an ACE inhibitor, angiotensin-receptor blocker, calcium-channel blocker, or thiazide-type diuretic. Among blacks, including those with diabetes, a calcium-channel block or thiazide-type diuretic is the best initial medication. Among individuals with declining kidney function, it’s best to start with a low dose of an ACE inhibitor or angiotensin-receptor blocker, since these types of medications help protect the kidneys from further damage.

Creating guidelines always challenges the experts

The previous set of blood pressure guidelines, published 10 years ago, were put together by a panel assembled by the National Heart, Lung, and Blood Institute (NHLBI), and carried the gravitas of a federal recommendation. The current panel was assembled by the NHLBI in 2008, but then was essentially cut loose when the institute announced it was getting out of the business of developing clinical practice guidelines.

The panel set out to base their guidelines only on data from randomized controlled trials , the gold standard of medical research. They openly acknowledged that this wasn’t possible, and instead had to base some of the recommendations on expert opinion. The recommendations are sure to draw criticism and create some controversy. To their credit, the panelists have said they would share all of the prepublication comments and communications between experts within and outside the panel.

I applaud the panelists for what they have accomplished. This was an incredibly difficult task.

Take-home messages

Although the new guidelines address an area of controversy—how low should blood pressure go—they don’t change the basics:

Know your blood pressure. Take advantage of any chance you have to get your blood pressure checked. For example, many pharmacies have blood pressure devices that you can use for free. Or consider using a home blood pressure monitor.

Consider high blood pressure to be a reading of 140/90 or greater. If you have high blood pressure, you need to act. This might mean just getting another couple readings in the next few weeks. If it is much above 140/90, call your doctor’s office to arrange an appointment soon.

Lifestyle changes are important. Since our lifestyles are often what lead to high blood pressure, changes can help control blood pressure. Key places to focus are getting more exercise, improving diet, losing weight if needed, not smoking, and reducing stress.

Tailor treatment to your needs. No matter what the guidelines say, your blood pressure treatment and goals should be tailored to you personally. For example, a very old and frail person is more likely to feel better and have less fall risk with fewer medications and a blood pressure higher than 150 or even 160.

Related Information: Diagnosis: Coronary Artery Disease

Comments:

  1. Alan

    Hello.
    Anyone had any success in lowering blood pressure if eating these listed foods below?
    Raisins
    If you suffer from hypertension, have raisins stirred into your morning cereals. Combine raisins with nuts. For best results, eat a handful of raisins three times a day.
    Bananas
    Eating foods that are rich in potassium can affect your blood pressure level. An ideal example of food that contains a lot of potassium and is not too expensive is a banana.
    Watermelons
    Consuming watermelons will improve the health of your heart. This healthy fruit contains a special amino acid which lowers blood pressure.
    Tofu
    Not only tofu, but eating all soy products can help people who struggle with elevated blood pressure as soy contains an ingredient called isoflavone which may help to lower blood pressure. Green tea also contains isoflavone.
    Chocolate
    Not expected to be on this list, but chocolate contains flavonoids, which may help to lower blood pressure. Do not buy a classic chocolate, but rather purchase a chocolate containing a high percentage of cocoa (at least 70%). Such chocolate is also filled with antioxidants. Do not overdo it though, as chocolate is very calorie-rich.
    Chili
    Many dishes can spiced with hot chili. Chili is rich in capsaicin, a substance proven to lower blood pressure.

    Regards, Alan

  2. Ross

    Daily activities like walking,meditation help to keep one fit and relieve stress, and thus control blood pressure.

  3. jordan

    Very usseful information,My uncle suffers from blood pressure issues.I would try to follow tips given i this blog.

  4. tips sehat

    Finally I can found this. this information very important for me. its because I got it too from my mother. thanks very much .

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  7. otty

    Eating raw garlic at least twice a week also reduces high blood pressure while combining it with fresh parsly will take away the typical garlic breath. The way garlic supposedly works is by dissolving greasy substances which get clogged
    to the inner walls of arteries. Garlic also happens to desinfect lung tissue which is also the case with dried aniseed which can even be eaten or rather chewed when having an empty stomach as opposed to garlic. Also, before eating garlic the heart of it should be removed since it is too bitter.

  8. Tiana Gustafson

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  9. Leslie Martin

    Great information. I am being treated for high BP.
    It is mostly caused by work stress. My BP gets elevated when I visit the doctor. It’s called white coat syndrome.
    How can I mitigate this?

    • G. Hill

      For more reliable information about your BP you can purchase a home cuff monitor and record your readings on a daily basis for a couple of weeks. Very helpful information for your doctor.

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