In “To Your Health,” the Washington Post (11/13) reports, “Acting for the first time in 14 years, the American Heart Association, the American College of Cardiology and nine other groups redefined high blood pressure as a reading exceeding 130 over 80, down from 140 over 90. This “change means that 46 percent of US adults, many of them under the age of 45, now will be considered hypertensive.” The Post points out that “under the previous guideline, 32 percent of US adults had hypertension.”
On its front page, the New York Times (11/14) reports that “under the guidelines…the number of men under age 45 with a diagnosis of high blood pressure will triple, and the prevalence among women under age 45 will double.”
Bloomberg News (11/13, Cortez) reports that the update “is based on a three-year review of almost 1,000 studies.”
USA Today (11/13, Painter) reports that “the guidelines presented at a heart association meeting and published in…the Journal of the American College of Cardiology, also spell out exactly how health care providers and people at home should check blood pressure.” For instance, physicians “and nurses are urged to let patients rest five minutes first and then to average at least two readings over two visits.”
Meanwhile, “patients are urged to take regular readings at home, with a device checked out by their health care providers.”
AMA Statement on Updated Guideline for Measuring Blood Pressure
BLOGFINGER MEDICAL COMMENTARY by Paul Goldfinger, MD, FACC.
This announcement is sensational because every doctor should adopt these new guidelines regarding diagnosis and therapy of hypertension, a disease that affects nearly half of our population. I would like to highlight some details of the new AHA/ACC report, fresh from the e-printers as of yesterday, November 13, 2017.
a. The cutoff criteria for diagnosing hypertension has been reduced to 130/80 from 140/90. Above that is hypertension, and there are some sub-categories. But even if someone has the “mildest” form (i.e. 130-139/80-89) the risk of stroke and heart attack is still substantial—twice that of those who have normal readings (i.e. under 120/80)
But keep in mind that a diagnosis must be made patiently. You don’t just obtain one reading and go by that. Multiple readings over a period of time are required, and most of these readings should be made at home.
Get a good home blood pressure device--Omron is best. They have many features, so ask your pharmacist and have him show you how to work it. Pay attention to the size of the cuff relative to the size of your arm. Follow the directions and wait 5-10 minutes before you take a reading and then wait another 5 minutes and take it again. Keep a record, and write down the second reading. Accuracy in measurement is critical.
b. The new criteria will result in a diagnosis of hypertension for nearly half the population. It was 35% before these new diagnostic criteria.
c. Those with Stage 1 hypertension (130-139 systolic or 80-89 diastolic) will be treated with life-style changes; not with medicine. But if a patient has Stage 1 along with heart disease risk factors (such as a cardiac history, obesity, vascular disease, diabetes, or high cholesterol, etc) then medications should be used.
And, regarding therapy, the new treatment goal is 130/80. It should be noted that even when the treatment goal was under 140/90, doctors often did not succeed in reaching those goals, so 130/80 may be difficult to achieve, and don’t forget that lowering BP with drugs, sometimes in combination, can be a risky business, with worrisome side effects. A skilled doctor will try to achieve the new goals, but by treading lightly and gradually.
Here is a link that looked at a goal of 120/80—with is even harder and riskier to accomplish.
d. Among the lifestyle changes are low salt (ie low sodium) diet. Remember that salt is a combination of sodium and chloride. So read labels and look for sodium content. Then keep your daily amount of sodium to less than 1,500 mg. (or 3,000 mg of salt.)
Also, if you are overweight, even a 10 pound weight loss can reduce the BP significantly. Other important aspects are well know to you all: exercise, reduce alcohol, stop smoking and deal with abnormal blood fats (lipids).
e. Regarding diet, the DASH diet is recommended. This is from our book:
“The DASH diet is a balanced 2000-calorie diet that is a good compromise between the very low fat diets and the American Heart Association diet. It has been recommended by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH publication # 98-4080). DASH stands for “Dietary Approaches to Stop Hypertension,” a clinical trial that evaluated the management of high blood pressure. The diet was recommended for patients with hypertension, but it is also beneficial in efforts to prevent heart disease and cancer.
DASH supplies 27% of calories from fat (mostly unsaturated) and includes a lot of fruits, vegetables, grains, nuts, seeds, beans as well as small amounts of unsaturated oil such as found in salad dressing, peanut butter and mayonnaise. The DASH diet recommends low fat dairy products such as yogurt as well as increased intake of calcium, potassium and magnesium.”
**From “Prevention Does Work–A Guide to a Healthy Heart.” by Eileen and Paul Goldfinger.
f. Speaking of fats: There has been a new view on dietary fats which has come out of a 2017 medical report. We will get to that, but it lightens up on the idea that we should have little or no saturated fats in our diets. In 1973, in Woody’s movie Sleeper, a man wakes up after 200 years asleep and finds out that saturated fats and smoking are good for you.
g. These guidelines are ultimately about survival-–so think about all your tomorrows.
And music is great for stress reduction–don’t forget that:
FRANK SINATRA: “All My Tomorrows.”
Here is a link to our post about hypertension in the elderly—-from March 2017
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