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Heart health guidelines updated: are you one of the millions now with high blood pressure?

New heart health guidelines released Monday mean millions more Americans are classified as having hypertension (SOURCE: WECT) New heart health guidelines released Monday mean millions more Americans are classified as having hypertension (SOURCE: WECT)
SOUTHEASTERN NORTH CAROLINA (WECT) -

Medical experts focusing on heart health released new guidelines Monday for high blood pressure, also called hypertension.

It’s safe to say most people would be overwhelmed with the new guidelines – 167 pages, citing 367 scientific publications, titled “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.”

What’s new and relevant to the average person?

  1. Millions more Americans will be classified as having high blood pressure, but this doesn’t necessarily mean more people will be put on medication.
     
  2. More accurate, and a possibly lower blood pressure normal for some people: instead of just one reading in the doctor’s office, the new guidelines emphasize an average of readings over several visits, plus home blood pressure readings.
     
  3. More guidance for how people should manage their blood pressure, focusing on lifestyle improvements. These include maintaining a healthy weight, following the DASH diet, lowering sodium intake, increasing potassium intake, lowering alcohol consumption, and increasing physical activity.

Normal blood pressure is still below 120/80, but now 120-129/80 is considered an “elevated blood pressure,” and 130-139/80-89 is “stage 1 hypertension.” Before, both these ranges were classified as “prehypertension,” and 140-159/90-99 was “stage 1 hypertension.”

"We’re lowering the number, but we’re actually raising the bar," said cardiologist Damian Brezinski, MD, who was not affiliated with the new guidelines.

The higher a person’s blood pressure, the higher their risk is of developing heart disease, which means they’re more likely to suffer poor health and die early, according to the guideline authors.

Even though a greater number of Americans may be considered hypertensive, the guidelines are upgrading how people track their blood pressure. Instead of a single blood pressure reading at the doctor's office, the authors recommend multiple readings in the office and at home.

"There’s a natural daily variation in blood pressure. Blood pressure can vary from minute to minute, sometimes from beat to beat," Brezinski said.

A person's blood pressure sometimes increases at the doctor, termed "white coat hypertension," and also is higher between 6 and 9 a.m., according to Brezinski.

He added that these more accurate blood pressure records mean, on average, people's blood pressure will tend to be lower than before. 

“You’re going to see that not a lot of people land on blood pressure medicines because when we factor (the averages) in, we’re going to see that blood pressure lowers just by taking those blood pressure readings at home," Brezinski said.

Here's what the guideline authors write:

“The prevalence of hypertension among U.S. adults is substantially higher when the definition in the present guideline is used versus the [older] definition (46% versus 32%)... However, most of the people now considered to have hypertension will be treated with lifestyle changes, like diet and exercise improvements, and not blood pressure medication."

“The new definition results in only a small increase in the percentage of U.S. adults for whom antihypertensive medication is recommended in conjunction with lifestyle modification."

Doctors are encouraged to prescribe diet and lifestyle alterations first for most patients, according to David Weaver, MS, interventional cardiologist at New Hanover Regional Medical Center. 

“Everyone should restrict the sodium in their diet," Weaver said, "and a good intake of fresh fruits and vegetables, foods that are high in calcium and potassium.”

Weaver said more people will likely be placed on blood pressure-lowering medications, but he hopes that providers try lifestyle modifications first.

The authors of the guidelines note that populations of black Americans have a higher prevalence of hypertension than white, Asian, and Hispanic Americans.

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