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New high blood pressure guidelines: Think your blood pressure is fine? Think again

March 28, 2019

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Comments

Liz Feinauer
November 23, 2017

The American Heart Association recommends using up the amount of calories you consume with aiming for 150 minutes per week of moderate intensity exercise or 75 minutes of vigorous activity-or a combination of both. Dietary guidelines recommend eating a variety of nutritious foods from all food groups including a variety of fruits and vegetable, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and non-tropical vegetable oils. It is also recommended to limit the amount of saturated fats, trans fats, and sodium. In order to lower blood pressure, it is recommended to consume more than 2,400 mg of sodium (approximately 1 tsp of salt). Reducing sodium down to 1,500 mg of sodium can reduce blood pressure even further, but reducing sodium intake by even just 1,000 mg per day can help reduce blood pressure. Also it is recommended to not smoke and avoid secondhand smoking (American Heart Association, 2015). As a registered dietitian, these new guidelines and the emphasis on a healthy diet and lifestyle seem to me that it will lead to increased need for dietitians who specialize in hypertension. Do you think that this will increase the job market for dietitians and wellness coaches in this health area?

American Heart Association. (2015). The American Heart Association’s diet and lifestyle recommendations. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WhbRcbS9-QA.

Dena Fox
November 27, 2017

Re ” it is recommended to consume more than 2,400 mg of sodium”
I think you mean “no” more than 2,400 mg.

azure
November 21, 2017

“While we always knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading.” So what? Does that mean that someone’s actually going to visit clinics all over the US to make sure that BPs are taken several times during the visit? Is that going to be added to the skin inspections (that aren’t done by the health care providers I have access to) done at every “wellness” exam? And the questions regarding mental health/depression that aren’t asked that are “now required”?

My BP gets taken once, when I arrive. Occasionally the top number is over 120. No health care provider has ever said anything to me about it. Only ONCE in the past 5 years, has any health care provider or assistant taken my BP again during the course of the exam to see if there’s been a change. So by your defintion, I’m getting poor clinical care. And that means what? As in, what will make that change? It sure won’t change for me raising the issue, I’m lucky if the provider even speaks to me. Providers spend more time staring at monitors then looking directly at the client/patient in the examination room.

Char barton
November 21, 2017

We live on hype daily about many things. Goalsetters we are. This is just another one, designed to raise our blood pressure about yet another thing. We gotta live/work harder-better -smarter. Sleep the same way. Dam. I feel my blood pressure rising already! Maybe less driven work, play, judgment; more relaxing, letting it go, loving what we are and have- is a better answer.

Stavros
November 21, 2017

Not only table salt adds sodium to our food but also sodium glutamate, a flavor enhancer used in processed foods and restaurants. Does someone knows if this is as bad as adding salt?

Elaine Shiner
November 21, 2017

High-blood-pressure medications used to have a reputation for causing symptoms that were worse than the disease. I hope that situation has changed. I’m sure that you’re sincere when you write that this is not about more medications, but, having observed the evolution of our health-care system for many decade now, I’m skeptical.

Sanjay
November 21, 2017

Normal BP level (130/80) may not be uniform across all the regions of the world owing to different life style and eating habbits. What is experts’ opinion on this?

Bhupender Kataria
November 21, 2017

Hi
What about our continued evolution? Are we saying that homo sapiens are stuck in time ? Being a science student I am totally puzzled. Our stomach was never made to digest wheat and rice and so many grains and pulseswe eat now but then this how we evolved from the cave dwelling and flesh eating beings to what we are today. Does any doctor estimated the systolic and diastolic of our ancestors ?

dr raj karwa
November 22, 2017

Katariaji, how come jains are vegan only??
With evolution our intestines n dentition are for veg n not for non veg
Dr karwa

Arnold Baise
November 20, 2017

It wasn’t long ago (2013) that those over 60 were advised to aim for blood pressure below 150/90. Now, as a result of a single large trial, the numbers are being revised in a major way. But as Dr. Gilbert Welch has pointed out at https://www.nytimes.com/2017/11/15/opinion/blood-pressure-guidelines.html , there are problems with this study. First, about 8% of patients aiming for 140 systolic (or less) had “cardiovascular events,” whereas only 6% of those in the 120 systolic group did. This is only a 2 point reduction, but as a percentage it’s a 25% reduction. This is the misleading use of percentage change instead of actual change. Second, the participants were already at higher than average risk for cardiovascular problems, so it was a study of a selected group and not of the general population.

Doc Mil
November 21, 2017

A reduction from 8% to 6% of cardiovascular events is known as an absolute risk reduction of 2%. This may seem small, but the translation is not small when applied to real world people. This can be understood more easily as something called “number needed to treat” which is calculated by 1 divided by the absolute risk reduction. In this case, an absolute risk reduction of 2% translates to a “number needed to treat” of 50 (1 divided by 0.02 = 50). This means that 50 people need to have a BP down to < 120/80 in order for 1 cardiovascular event to be prevented. In the context of many other things we do in our life (medical treatment or not), this is really good!

For example, did you know it takes 10,000 mammograms done yearly for 10 years, in order to just prevent 10 breast cancer deaths?
https://jamanetwork.com/journals/jama/fullarticle/2040228

Of note, I am a primary care doc.

Grace Williams
November 20, 2017

Grace Williams
I’m just turn 56 years and for the past 8 month my blood pressure was high, now it is even dangerously high. Was 154 over 82 now it’s 189 over 82 or 92 . It really scares me, I know that I can have a stroke or heart attack. My weight is 191 and my height is 5’7. Eats health. No meat or dairy. Just stress out from work. Need some help.

Nita
November 21, 2017

Exercise may help. Walking at a brisk pace for 1/2 hour most days, then adding 15 minutes to the walk every week. It doesn’t have to be done all at once-walk 15 minutes in the morning, 15 at lunch, and 15 after supper. Get a friend or neighbor to walk with you and the time will go by quickly.

Ghpkap
November 20, 2017

What about the food industry? I cook almost all my meals, when I go out to eat, if I do not specify no seasoning, I can’t even take one bite due to the excessive amount of salt added to the food.
I think at this point any restaurant or food industry that adds excessive salt should be taxed commensurately to help defray the cost for health care. The salt is killing us.

I travel extensively, and our country by far uses too much salt in processed and restaurant food.

Perhaps you can can help educate people and force the food industry to change! One can only hope.

John O
November 21, 2017

Give me a break. Most people don’t use restaurants for their every-day eating— it’s a special occasion intended to be more indulgent than a normal meal. Your distaste for salt shouldn’t affect the level of seasoning in my Birthday dinner.

Nita
November 21, 2017

I agree. Eating at home is the only sure way to keep your bp down. Way too much salt in restaurant meals.

Jeanne Miller
November 20, 2017

Why do I get up in the AM with enormously high B P? Usually 180 over 85 with a 53 pulse?

Monique Tello, MD, MPH
November 20, 2017

Excellent point! I can’t speak for anyone specifically, but I can say that generally, doctors make the worst patients. We don’t always follow the textbook guidelines nor abide by health recommendations. Then, there’s genetics, a pretty powerful force, and one over which we have little control. And, of course, there is just plain bad luck (or fate, finger of God, however you choose to describe it). So, many factors can come into play when a doctor gets diagnosed with what can otherwise be considered a preventable disease.

Sara Shannon
November 19, 2017

Please stop saying “unhealthy fats.” Tell people what the sources of those unhealthy fats are specifically.

Monique Tello, MD, MPH
November 20, 2017

Very good point! This August 2017 post all about dietary fat will hopefully tell you everything you want to know:
https://www.health.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good

Sotirios
November 17, 2017

If you and your colleges at AHA are right about cvd, how come their president got a heart attack recently? Get real and level with us tha you do not know what is the cause and next u don’t know how to prevent or treat it right ,

Commenting has been closed for this post.

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