Heart disease is the leading cause of death in the United States. Plenty of risk factors for heart problems exist, but hypertension—high blood pressure—is the most common one. Fortunately, it’s also the most treatable.
Measuring your blood pressure is a routine part of every doctor’s visit. This summer, the American Heart Association (AHA) and the American College of Cardiology released new guidelines that change the definition of high blood pressure and what that means for possible treatment. John J. Szawaluk, MD, a cardiologist with The Christ Hospital Physicians and Medical Director of The Christ Hospital Resistant Hypertension Clinic, explains the notable aspects of the update and why they are important for long-term health.
“High blood pressure is the most preventable factor for the development of cardiovascular disease, heart failure, atrial fibrillation, stroke, dementia, chronic kidney disease and overall all-cause mortality,” he says. “These new guidelines can help us raise awareness and make better headway with earlier treatment.”
A new definition of high blood pressure
The most important change is the updated categories that define hypertension, and how they allow for an earlier intervention. The updated guidance lowers the threshold for high blood pressure from 130/80 (systolic/diastolic) to 120/80 under the new category of “elevated blood pressure,” meaning the goal for normal blood pressure is less than 120/80.
Based on this change, more than half of American adults have elevated blood pressure, which comes with an increased risk of reaching stage 1 hypertension or higher, so doctors can address concerns about blood pressure earlier, before they lead to more serious complications.
“We’re now putting an emphasis on bringing a patient’s blood pressure closer to 120/80 and lower,” Dr. Szawaluk says. “With that threshold change, we have a whole new population of people who should start therapy.”
An earlier, more aggressive start to treatment
Dr. Szawaluk says the new guidance encourages doctors to treat patients for high blood pressure earlier and with more intensity.
“We used to start low and go slow as we increased medication,” he says. “Now, it’s recommended that we start earlier and go faster.”
Doctors should use a risk-based approach that evaluates your overall health when deciding on the best treatment plan for you. Depending on your blood pressure and other underlying conditions, your treatment could include medications like angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, calcium blockers and diuretics, or combination therapy.
Earlier treatment is critical to help avoid more complicated health problems, Dr. Szawaluk says.
“Starting blood pressure treatment earlier can translate into a significant drop in cardiovascular risk for patients,” he says. “The longer their blood pressure stays high, the greater chance they’ll develop target organ damage that can affect the heart, kidneys, brain and eyes.” He adds that every one mm reduction in systolic blood pressure translates to about a two percent relative risk reduction in the risk of major cardiovascular events. For every 10 mm Hg reduction in systolic blood pressure, patients experience a significantly reduced risk of coronary heart disease, stroke, heart failure, major cardiovascular events, and all-cause mortality.
A connection to dementia
New research shows that high blood pressure damages the blood vessels in your brain. That type of injury is linked to cognitive decline and memory problems.
“We’ve learned that cognitive decline is a side effect of long-term uncontrolled hypertension,” Dr. Szawaluk says. “Intensive blood pressure lowering can decrease that risk.”
In fact, he says, successfully reducing your blood pressure can lower your dementia risk by 15 percent. To reach that goal, the new guidelines recommend that people with high blood pressure start treatment as early as possible.
A new risk score for prevention
Knowing your risk for future cardiovascular disease can help you take steps to prevent negative events like heart attack or stroke. The new guidelines introduced the PREVENT™ risk calculator. It provides the insight doctors need to deliver the care you need.
This risk score uses a patient’s age, blood pressure, cholesterol level, sex and other health indicators, including zip code, to calculate their 10-year and 30-year risk of heart disease. It’s accurate for people between 30 and 79. It also examines heart, kidney, and metabolic health.
Dr. Szawaluk says doctors can use this precise risk assessment to create personalized treatment plans.
“This score gives us a personalized number that we can discuss with the patient. We can explain their specific 10-year and 30-year risks,” he says. “That’s helpful when you have a young person sitting across from you who needs medication but may not want to take it. Being able to show them how treatment can lower those risks significantly is powerful.”
Self-care steps for lower blood pressure
Prescription blood pressure medication is just one way to lower or control blood pressure, Dr. Szawaluk says. While some factors such as family history, age, and race are out of a patient’s control, there are steps you can take to lower your risk. The updated guidelines recommend lifestyle changes that can lead to significant improvements.
Eat a healthy diet: Choose a diet that includes a wide variety of fruits, vegetables, whole grains, legumes, nuts, seeds, lean meats and nonfat or low-fat dairy. Follow a low-sodium diet like the DASH diet to keep your daily salt intake below 2,300 milligrams (about 1 teaspoon), with a goal to actually try to limit yourself to 1,500 milligrams a day.
Exercise: Get at least 30 minutes of exercise five days a week. You don’t need a gym membership—walking is a great activity to help lower your blood pressure. Dr. Szawaluk says the key is to simply get moving.
Get an at-home monitor: An at-home blood pressure monitor lets you keep track of your daily blood pressure. Choose a monitor validated by the American Medical Association that uses an arm cuff to take the measurement. To get an accurate reading, follow these how-to instructions from the AHA. Avoid blood pressure monitoring kiosks in grocery stores or commercial pharmacies. Those machines aren’t necessarily routinely serviced and may not provide accurate results, Dr. Szawaluk says. Not to mention, results could be skewed by the level of activity that comes with visiting that kiosk.
Limit alcohol: If you can, avoid alcohol. If you choose to drink, keep it to no more than two drinks daily for men and one drink for women.
Maintain a healthy weight: If you’re carrying additional weight, losing just 5 percent of your body weight can lower your blood pressure. Talk with your doctor to determine a healthy weight for you.
Hypertension is common. Dr. Szawaluk says up to 80 percent of middle-aged adults will develop it during their lifetime. So, it’s important to pay attention to your blood pressure early. This new blood pressure information supports doctors’ efforts to improve heart health outcomes for you and other patients.
“The update in the guidelines about risk levels and the introduction of the PREVENT risk score will help us move toward treating people with high blood pressure earlier,” he says. “It gives us an opportunity to be more aggressive with treatment decisions.”
Concerned about hypertension? Talk with your primary care provider or schedule an appointment with the high blood pressure team at The Christ Hospital Health Network.