Here's what is new with Blood Pressure?
Hypertension is a very prevalent condition in the US in the
over 60 population over 65% are considered to be hypertensive.
Blood pressure is the leading risk factor for CV
(cardiovascular) morbidity and mortality which is the number 1 cause of death
in women and number 2 in men. Other risk
factors include diabetes, obesity and smoking.
In the African American population hypertension rates are
higher, it presents earlier and tends to
be more severe that in Caucasians. They also have the highest incidence of
kidney disease, cardiovascular disease and stroke from it than other
ethnicities.
Every few years a group of experts (gurus) get together to
make recommendations about how to diagnose, treat and manage HTN. This group is
put together by the NIH and they are called the Joint National Commission or the JNC.
The latest recommendations are
those of the JNC8 published in 2014. Before that was 2003 (JNC 7) so you can
see that they don’t meet too often, once or twice a decade.
Be that as it may, the current guidelines have taken us
backwards in terms of defining hypertension. There was a time when the goal for
blood pressure was 120/80 and still is, for some very high risk people however
for most people here are the new numbers:
If you are over 60 you are not hypertensive until your BP is
>150/90, under 60 they suggest you
begin treatment when your pressure is over 140/90. Also new is an
acknowledgement that we should not be over treating blood pressure in the
elderly.
Black patients, elderly and diabetics are at greatest risk
of hypertension complications.
The JNC8 also addressed treatment of blood pressure and
suggested different starting medications for African American and Caucasian
patients because they work differently.
JNC 1 through JNC 4 recommended a step wise approach to
blood pressure treatment but now one can start with a variety of medications
and if one is not working adequately after a month of use they suggest another
medication be added. A third one may be needed if maximum doses of the first
two do not control the blood pressure.
The best blood pressure measurement is the one you do
outside the office! Some actually recommend that the elevated blood pressure be
confirmed outside to avoid ‘white coat syndrome’ before starting treatment.
Some insurances will pay for a 24 hour ambulatory blood pressure
monitor to confirm what a patient’s blood pressure is when they are up and
moving around.
There is the DASH diet which people with hypertension should
try to follow, cut down salt intake and drink adequate amounts of water.
Always have your blood pressure checked at least twice a
year and if you are on medication at least monthly at home.
People on blood pressure medication need to have their blood
checked periodically for kidney and liver function and diabetes.
At the end of the day high blood pressure is a serious
condition and should be handled as such. It should not be taken lightly as it
causes a lot of premature death.
