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.
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:
- First and foremost, take the lifestyle suggestions above very seriously. Here’s an AHA link that will help you understand risk factors and how you can significantly modify some of them with lifestyle changes.
- Have your blood pressure checked regularly.
- If your blood pressure is slightly elevated, get an at-home blood pressure unit, take your blood pressure two to three times a week at the same time of day, and record your readings for your doctor to review.
- Appreciate the significance of a less-publicized report, also released last week, showing that compared to 11 other so-called wealthy countries, older Americans have the most chronic illnesses. 36% of Americans over 65 have three or more chronic conditions, including complications of high blood pressure. By comparison, it’s 3% in Sweden and 4% in the UK. This immense disparity is attributed to health insurance (including Medicare) failing to cover preventive measures.
And yes, again I remind you to take charge of your health.
David Edelberg, MD