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Blood pressure guide: 130 is the new 140

By on March 29, 2018 in Columnist with 0 Comments

Jim BrownBy Jim Brown, M.D.

In recent months the American College of Cardiology and the American Heart Association released new guidelines on hypertension (high blood pressure).

These new guidelines are the product of three years of thorough review by a panel of 21 experts who reviewed over 900 sources.

These new ACC/AHA Hypertension Guidelines make systolic blood pressure of 130 the new 140. The definition of normal blood pressure, 120 over 80, hasn’t changed.

Systolic blood pressure of 120 to 129, even if the diastolic pressure is less than 80mm is now considered elevated.

Levels of 130-139 or 80-89 were previously called pre-hypertension but now are considered Stage 1 hypertension.

It was felt that labeling blood pressure as “pre-hypertension” does not suggest to patients that they had a significant issue with their blood pressure whereas people with blood pressure in that range actually do have a substantial risk.

In fact they have double the risk of heart attack compared with somebody in the normal blood pressure range of less than 120 over 80.

Stage 2 hypertension is a systolic blood pressure of 140-159 or a diastolic blood pressure of over 90-99.

Above that level is obviously a serious issue.

The higher number (systolic blood pressure) indicates how much pressure your blood is exerting against the artery walls when the heart ventricles contract sending oxygenated blood out to our body. The lower number (diastolic blood pressure) indicates how much pressure our blood is exerting against our arteries’ walls when the heart is resting and filling with blood between beats.

Patients often wonder which number is more important. They both are important but more attention is often given to the systolic blood pressure (upper number) as a major risk factor for cardiovascular disease for people over age 50.

Systolic blood pressure rises with age due to the increasing stiffness of our arteries as well as the build-up of cholesterol plaque in our vessels.

Blood pressure is measured in mm Hg (mercury) since mercury was used first in accurate pressure gauges and is still used as the standard unit of measurement for pressure in medicine.

The risk of death from ischemic heart disease doubles with every 20mm Hg systolic or 10 mm Hg of diastolic increase from ages 40-89.

As for treatment, the prior guideline recommended a target of less than 140/90 mm Hg. The new guideline recommends a target of 130/80 mm Hg.

The rationale for this more intensive blood-pressure goal of less than 130/80 mm Hg particularly in older adults is largely based on more recent anti-hypertensive treatment trials.

About 75 million Americans have high blood pressure, or one of every three adults. Only about half of people with high blood pressure have their condition under control. It is estimated that high blood pressure costs the nation $46 billion annually, which includes cost of health care services, medications and missed days of work.

Women and men are equally likely to develop hypertension in their life times; however, for those over age 65, more women have hypertension than men. Blacks develop hypertension more often than Caucasians and Mexican Americans less often.

You might wonder why blood pressure really matters. The statistics are sobering.

In recent years about 360,000 American deaths included hypertension as a primary cause, which amounts to 1,000 deaths daily. About 7 of every 10 people with a first heart attack have hypertension. About 8 of 10 people having their first stroke have high blood pressure, and 70 percent of people with chronic heart failure had high blood pressure.

Another increasingly important issue is that of white matter lesions in the brain, known as leukoaraisis.

These are detectable on brain computed tomography (CT) scans as diffuse hypo-density white matter, while on MRI imaging they appear as hyper-dense lesions.

In addition to indicating a predisposition to stroke, white matter lesions are frequently found in the presence of cognitive impairment, of which they are a predictive factor.

There are two main risks factors for white matter lesions (WML): Advanced age and high blood pressure.

In stroke patients, CT or MRI reports often describe chronic WML in addition to the acute stroke lesion. They are not present in everyone who has a stroke who also has hypertension, so it is thought that there are likely additional risk factors other than hypertension alone as a cause of WML.

A recent study looked at a stroke unit in Italy. Some 321 consecutive patients were admitted over a two year period with either a hemorrhagic stoke or an ischemic (deficient supply of blood to a body part due to obstruction of an artery) stroke. Two groups of patients were identified, those with WML and those without.

Patients who had WML and were on average 11 years older than those without WML, had a higher incidence of high blood pressure and were more likely to be female.

In recent years more people with hypertension, especially those over 60, have become aware of their condition and are being treated.

Unfortunately, about one of five American adults with high blood pressure still don’t know they have it, and that is why hypertension is called “the silent killer.”

Americans make over 50 million visits to their medical providers for treatment of their elevated blood pressure. There are many different medications available to treat hypertension that need to be prescribed by their physician.

Also there are lifestyle changes that patients can and should take. These changes are ones I have mentioned frequently for many medical conditions as well as preventive measures to try to help everyone live a healthier lifestyle.

They include a healthy diet that is low in salt (sodium), saturated fat, cholesterol. Increasing one’s intake of potassium is also important. Our diets should emphasize fresh fruits and vegetables.

Do not smoke! If you do smoke quit as soon as possible or get help to quit. I know this is easier said than done, but if you value your health and your heart, you need to stop smoking.

Being physically active is also extremely important. Try to take a brisk 30-minute walk three to five days a week.

Personally, I have found that getting a dog can have great benefits. Dogs need to be walked daily. It helps your dog but also helps you. Not only that, dogs love us unconditionally and are more than willing to be our best friend.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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