What's new with Blood Pressure?

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.