Richard Davis: This is the new normal

Blood pressure is one of those health indicators that is easy for people to ignore. They don't feel the effects of un-managed blood until it's usually too late to do anything about it. That is why high blood pressure is often referred to as the silent killer.

When their cardiovascular system is so stressed that people are in an advanced state of heart failure or have a stroke or some other catastrophic event, all they can do is to ward off the inevitable with drugs and prayer because they have not kept an eye on their blood pressure for too many years.

In 2017 the American Heart Association and the American College of Cardiology came up with new guidelines for determining when a person has high blood pressure. They are sensible changes and they do not urge most people to jump on the medication bandwagon without trying some simple, but usually difficult lifestyle changes, such as diet and exercise.

Prior to their new recommendations it was thought that a blood pressure up to 130/90 was normal but, when it came close to that upper limit, it needed watching. Now the standard is that normal blood pressure cannot exceed 120/80 and that once it goes above 130/80 a person is considered to have high blood pressure. That level above 130/80 is now called Stage 1 hypertension. Blood pressure between 120-29 and up to 80 is now called elevated BP.

Stage 2 hypertension is from 140-159 or 90-99 and the next level is more than or equal to 160 or more than or equal to 100. It is worth reading the recommendations as outlined in a December 2017 Medscape report.

Here are a few.

"The guidelines recommend the use of BP readings out of the medical office to confirm the diagnosis of hypertension and titrate therapy. Patients should consider weekly readings, especially after changes in treatment and before clinic visits.

The use of ambulatory 24-hour BP monitoring is particularly recommended in the evaluation for white coat and masked hypertension.

Lifestyle measures can be effective in treating hypertension. Following the DASH diet can reduce BP by an average of 11/3 mm Hg. The combination of restricting dietary sodium and increasing dietary potassium can result in almost as robust an effect.

The new recommendations call for testing for thyroid-stimulating hormone levels among patients with newly diagnosed hypertension.

Pharmacologic treatment of hypertension is most effective among patients at the highest risk for cardiovascular events.

Antihypertensive therapy is recommended as secondary prevention for cardiovascular disease when the BP exceeds 130/80 mm Hg, or when the estimated 10-year risk for cardiovascular disease is 10 percent or more.

Other patients may receive medical treatment when the BP exceeds 140/90 mm Hg. A BP target of less than 130/80 mm Hg can be reasonable for these individuals, including adults older than 65 years.

BP should be reevaluated within 1 month of the initiation of antihypertensive therapy.

Treatment with an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker concurrently is not recommended. First-line agents for hypertension include diuretics, calcium channel blockers, and ACE inhibitors or ARBs."

The unique aspect of most of these recommendations is that they are not too costly. In fact, even if a person is prescribed first line prescription medication to treat high blood pressure they could expect to pay less than $10 a month for the pills.

The hard part is making changes to diet and finding a way to get regular exercise. High blood pressure is a disease than can be prevented, in many cases, with a sensible regime of diet and exercise. It is also a disease that each of us can have control over, and that is a rare thing in today's world of high tech health care.

Richard Davis is a registered nurse. He writes from Guilford and welcomes comments at The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.


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