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130/80: What The New High Blood Pressure Guidelines Mean For You

You might not have known it, but last Monday, November 13, 2017, you may have awakened with high blood pressure (hypertension).

Don’t feel alone.

A massive increase in the number of people with hypertension occurred overnight when the definition of high blood pressure was officially changed from 140/90 (and higher) to 130/80 (and higher). I’m not big on sports metaphors, but were you to move the goalposts closer to each other, very likely each team would score more goals.

On Sunday, there were 77 million Americans with high blood pressure. On Monday, under the new guidelines, that number jumped to 115 million. On Sunday, 31% of us had high blood pressure. On Monday, it was 46%.

How did this unfold and what does it mean for you?
First, in case you missed that day in science class, some background on blood pressure. Understand that any fluid in a closed system–the plumbing in your house, for example–moves under a certain amount of pressure. We wonder why water trickling from a bathroom faucet is under low pressure.

It’s the same with the blood vessels throughout your body, except in this case your blood is under two different pressures.

  • Systolic blood pressure, the first number, occurs when your heart contracts to push blood forward.
  • Diastolic blood pressure, the second number, occurs when your heart is relaxed.

Every time you have your blood pressure taken, two numbers are recorded. 120/80, for example. The 120 is systolic, the 80 diastolic. These readings indicate the force your heart is exerting to pump blood around your body.

Problems occur when the pressure in this closed system (which includes your heart and blood vessels) starts to rise. The rising pressure begins to damage vital organs everywhere in your body. In your brain, high blood pressure can lead to a stroke. A high blood pressure predisposes you to heart disease. Your kidneys and eyes are at serious risk too.

Theories abound as to why blood pressure goes up, but most likely it’s a combination of genetics, poor lifestyle choices, stress, and possibly the toxins in our environment.

New normals
The decision to establish which numbers signal high blood pressure, and which do not, was not made lightly. The last major guideline shift occurred in 2003 when any reading above 140/90 was definitely high and any above 130/80 merited careful watching.

Last Monday, those numbers all dropped ten points. 130/80 and above is the new high blood pressure. 120/80 and above now merit careful watching in case the numbers rise. Ideal blood pressure is 120/80 and lower.

An undeniable group of experts agreed on these recommendations. After combing through reams of clinical studies, the new guidelines are from the American College of Cardiology and the American Heart Association. You can see the experts’ credentials here.

Does this study mean the 37 million Americans who thought they were just fine on Sunday are now not as healthy as they thought? That’s about the size of it.

There has been some pushback from primary care physicians. With nearly one million practicing physicians in the US, don’t expect full agreement on anything. Click through to this link to see a provocative range of opinion.

Report advises proceeding with caution
It’s tempting to view this as a huge play in favor of Big Pharma. By any measure, 37 million new users of blood pressure drugs is no small number. But as doctors frantically comb through patient charts to identify the newly hypertensive and phone in prescriptions, the report also recommends that doctors proceed with caution.

Doctors (and thus their patients) are advised to:

  • Begin by recommending lifestyle changes. This is definitely our route at WholeHealth Chicago: healthy diet (low-salt DASH diet is best); weight loss if overweight; regular exercise; no tobacco; alcohol in moderation; and increasing potassium by eating more greens. I also suggest eating raw celery every day because several studies have shown it lowers blood pressure. Useful supplements include fish oil (1000 mg daily), CoQ10 as UBQH (50 mg, twice daily), and magnesium (400-600 mg daily).
  • Ensure it’s not white-coat hypertension. Don’t start medication for borderline high blood pressure until you have the patient check her blood pressure on her own turf.
  • Take a step back and look at the big picture. If a patient with minimal high blood pressure comes from a family where everyone has heart disease and early deaths, be more aggressive treating blood pressure than with a person whose family members live into their 90s.
  • Add medication cautiously. Several of the older blood pressure medications can cause more trouble than they’re worth. Diuretics (water pills) lower blood levels of potassium and increase the risks of gout and diabetes. Beta-blockers can cause lightheadedness when standing up too quickly. The Lisinopril family can trigger constant coughs. I mainly prescribe angiotensin II receptor blockers, ARBs for short (all end in the syllable “sartan,” like losartan).

Patients (quite possibly, you) should:

And yes, again I remind you to take charge of your health.

Be well,
David Edelberg, MD

Leave a Comment

  1. Diane says:

    If I take Losartan it makes me swell up and I have to take the water pills anyway. When I quit smoking my blood pressure was too low. I quit taking the Losartan and kept taking the water pills. My blood pressure has stayed at 120/80 ever since then. I tried giving up the water pills too but my blood pressure went up. High blood pressure runs in my family but everyone lives to be at least 80. It must be difficult to treat patients since no two people are exactly alike.

  2. Peter Merkle says:

    Yes, thank you. Take charge of your health. But if this doesn’t play as the sound of Big Pharma and the shoveling of scripts I’m a monkey’s uncle.

  3. Laura says:

    Keeping to healthy diet is highly important, but it’s not always easy to control your daily ration. In this case the best choice is using of a nourishment journal, measuring your salt intake (it should be less than 2,300 milligrams per a day).

  4. R says:

    Hi Doc! I have been on amlodipine for years before (maybe 8 yrs), now on lozartan. Bp has mostly been ok, but sometimes not, even at home because of anxiety when using b.p measuring device. Sometimes initial measurement will be high, but 2nd and 3rd try will be low. Again most probably because of anxiety. Well, I actually have anxiety disorder. Trying therapy, meditations now. I’m 40 years male BTW. Just recently though, I have this spells where I could feel pressure going up from the back of my neck to my head, I’ll be dizzy, and feel like fainting, have to hold on to something. 2 times it happened already since my last anxiety attack last Nov. 2017 and since I started with Losartan 50mg. I thought I was gonna faint or was having a stroke. Both happened in the evening, I was sitting doing work, got up, went down the stairs, then it happened. Funny thing is I was actually thinking anxious stuff when going down the stairs both times it happened. Oh, I also would have some dizzy spells from sitting to standing months ago. One time I measured my bp when I rose dizzy from my bed, and my bp was only 90/60. So it’s hypotension right? Again, I started feeling that with I’m kinda new with Losartan. After a few weeks to now, it lessened though, and almost doesn’t happen already. It’s just this rising head pressure and feeling faiting that happened again tonight.

    Question is, am I still having side effects of the losartan drug, hypotension or not? Is the feeling of faint and rising pressure to my head a headrush, or hypotension also? Or is it just because of my anxiety issues? Gonna go to the doctor again tommorow actually to tell him about the rising head pressure, dizziness. If I could just visit you there, but I’m here in asia. 😀

    Hope to hear from you good doctor. 🙂

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