QUESTION:

I thought my blood pressure was OK, but now I’ve been told I have hypertension. What are the newest guidelines? Does this mean I’m going to have to take medication?

ANSWER:

Previously, 140/90 mm Hg was considered to be high blood pressure (hypertension). The American College of Cardiology (ACC)/ American Heart Association (AHA) guidelines released in November 2017 are more strict. However, even if you are diagnosed with hypertension, your blood pressure not be high enough to warrant medications. You and your doctor and/or pharmacist can develop a plan to meet your personal goal. Healthy lifestyle changes will be a part of that plan.

Before we talk about those changes, let’s take a look at the new definitions.

BP Category Systolic BP   Diastolic BP
Normal <120 mm Hg and <80 mm Hg
Elevated 120-129 mm Hg and <80 mm Hg
Hypertension Stage 1 130-130 mm Hg or 80-89 mm Hg
Hypertension Stage 2 ≥140 mm Hg or ≥90 mm Hg

 

Why are the guidelines important?

It is estimated that almost half of American adults have high blood pressure. If you are one of these estimated 103 million, you have a bigger risk for heart disease and stroke – these are the first and third leading causes of death in the United States.

This is especially concerning since hypertension is known as the “silent killer.” Often, there are no signs or symptoms. Many people don’t even know they have high blood pressure.

What You Can Do To Lower Blood Pressure

  • Get your blood pressure checked regularly – and not just in the doctor’s office
    • If you don’t have a blood pressure cuff at home, many pharmacies and grocery stores have machines where you can get it taken.
    • Record your readings, including date and time, to discuss with your doctor. Following trends can show how well your lifestyle changes are working.  A handy blood pressure log can be found here.
    • If you have recently exercised, had caffeine or feel stressed, your blood pressure may be briefly elevated. So do your best to not take your blood pressure during these times.
    • Best practices for taking your blood pressure include:
      • Staying seated for 5 minutes before taking the reading
      • Keeping your feet flat on the floor with your back straight
      •  Don’t talk while the reading is being taken
  • Smoking can raise blood pressure
    • Nicotine raises blood pressure
    • It can increase the systolic blood pressure (top number) by 8-9 mm Hg after smoking a cigarette
    • Smoke can damage the heart and blood vessels
  • Cut back on caffeine
    • Habitual coffee drinkers had reduced blood pressure when they quit or switched to decaffeinated.
    • Caffeine can raise blood pressure by as much as 10 mm Hg in people who rarely consume it
  • Limit the amount of alcohol you drink
    • Generally, having more than one drink a day for women and men older than 65 years old, or having more than two drinks a day for men 65 years old and younger can raise blood pressure by 2-4 mm Hg.
  • Exercise regularly
    • Regular activity for at least 30 minutes most days of the week can lower your blood pressure by 4-9 mm Hg
    • Exercise can increase blood pressure acutely, so don’t take your blood pressure immediately after exercising. It won’t be an accurate representation of your blood pressure control
  • Lose extra pounds
    • As weight increases, blood pressure also often increases.
    • Disrupted breathing (sleep apnea) can be caused by being overweight.
      • Sleep apnea can in turn raise blood pressure
  • Reduce stress when possible 
    • Chronic stress contributes to high blood pressure.
    • So can occasional stress if you react to it by eating unhealthy food, drinking alcohol or smoking.
    • Here are some tips to help you manage anxiety and stress.
  • Eat a healthy diet with reduced sodium/salt
    • Consider a diet like the DASH diet – Dietary Approaches to Stop Hypertension.
    • Eat a diet with lots of whole grains, fruits, vegetables and low-fat dairy products..
    • Cut back on foods that are high in saturated fat, cholesterol and trans fats.
    • Reduce sodium by reading food labels, eating fewer processed foods and not adding salt to your foods. Use herbs or spices instead.
    • This combination can lower your blood pressure by up to 14 mm Hg

 

Do I have to do everything at once?

No. Remember, one of the things that helps lower blood pressure is to reduce stress. If your blood pressure is consistently above 120/80 mm Hg, work with your doctor or pharmacist to set your personal goal and develop a plan.

At first, try picking an area or two to focus on. Then, you can add additional goals over time. Even small changes can reduce your risk for heart disease and stroke. As you can see from the potential blood pressure reductions listed above, there are a lot of ways to get to your goal.

The important thing is to start taking action to bring your blood pressure down.

References

  • American College of Cardiology. (2017, November 15). The 2017 High Blood Pressure Guideline: Risk Reduction Through Better Management. Retrieved from Cardiology Magazine: http://www.acc.org/latest-in-cardiology/articles/2017/11/14/14/42/the-2017-high-blood-pressure-guideline-risk-reduction-through-better-management
  • American Heart Association. (2017, November). 2017 Hypertension Guidelines. Retrieved from American Heart Association: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure-or-Hypertension_UCM_002020_SubHomePage.jsp
  • American Heart Association. (2017). Blood Pressure Log. Retrieved from American Heart Association: http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_305157.pdf
  • Anxiety and Depression Association of America. (2017). Tips to Manage Anxiety and Stress. Retrieved from Anxiety and Depression Association of America: https://adaa.org/tips-manage-anxiety-and-stress
  • Centers for Disease Control & Prevention. (2017, November 13). High Blood Pressure. Retrieved from Centers for Disease Control & Prevention: https://www.cdc.gov/bloodpressure/index.htm
  • Maria Heller, M. R. (2017, July). The DASH Diet Eating Plan. Retrieved from The DASH Diet: http://dashdiet.org/default.asp

Jeannette Bernay, Doctor of Pharmacy Candidate 2018