Have you ever had high blood pressure? If not, chances are better than ever that you do.
The reason? Experts have moved the goalposts.
That’s usually an unfair act. But in this case an exception is warranted, because it could save lives.
Recent research indicates the risk of dying from heart disease, the world’s No. 1 killer, is reduced for folks who maintain the new, more stringent standards.
A reading of 130/80 or higher now means you have high blood pressure, according to revised guidelines issued by the American Heart Association, the American College of Cardiology, and nine other health groups.
Before experts learned the remarkable effect of maintaining the lower thresholds, they set them at 140/90 for the under-65 crowd and 150/80 for folks 65 and up. The new thresholds does not distinguish by age.
Check It at Home
People with blood pressure over the new limits should be advised by their physician to modify their diet, move more, and check their readings regularly, probably with the aid of a home health monitor.
If you don’t have a blood-pressure monitor at home, now may be the time to invest. Decent units cost about $40 to $100. Insurance may cover part or all of it.
A monitor helps you stay on top of hypertension by making it possible to measure your blood pressure a few times a week. Any significant changes warrant a trip to the doctor.
Consumer Reports, which has tested and published ratings of the monitors, offers this advice:
— Make sure the sensor cuff is designed to go around your upper arm. It’s more accurate than the ones that fit your wrist or fingers, according a study in the Journal of Clinical Medicine Research.
— Choose an automated monitor, the kind with a self-inflating cuff.
— Look for a digital readout that is large and bright enough to see clearly.
— Consider a monitor that plugs into your smartphone to transfer the readings to an app that records and creates a graph of your progress.
Once you’ve acquired a home monitor you’re happy with, you’re halfway there. Next, learn how it works, and use it, starting with these pointers:
— Avoid caffeinated or alcoholic beverages at least 30 minutes before checking your blood pressure.
— Sit quietly beforehand for five minutes with back supported, legs uncrossed.
— Support your arm so your elbow is at or near heart level. Wrap the cuff over your bare skin. Don’t talk during the measurement.
— Leave the deflated cuff in place afterward, then wait a minute and take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
— Keep a running record of your blood pressure readings, including time of day.
Factors to consider in a home monitor include whether its cuff fits your upper arm, cost, insurance coverage, ease of use, additional features, and a readout large enough to see without a magnifying glass.
That’s according Consumer Reports, the nonprofit that independently tests and compares consumer goods, then publishes the results.
Depending on your situation, some extra features to consider for a home monitor are: an irregular-heartbeat detector, a risk-indicator, memories for multiple users, cuffs of different sizes, memory download capability, and data averaging.
Of the 20 arm monitors rated in the January 2019 issue of Consumer Reports, Rite Aid’s Deluxe Automatic BP3AR1-4DRITE was listed as a “Best Buy.” The full ratings, at consumerreports.org (membership required) will help determine which unit is best for you.
One-Third of Adults Affected
With the aging of the population and increased life expectancy, the prevalence of high blood pressure is expected to continue to increase,” laments epidemiologist Dr. Paul Muntner, who teaches at the University of Alabama at Birmingham.
The tightening of target blood-pressure readings created the worrisome new reality that 70 to 75 percent of U.S. men age 55 and up now have high blood pressure, Muntner told American Heart Association News.
Put another way, one in three adults is now affected, both in the U.S. and globally
The standards that reclassified many people as having high blood pressure stemmed from the results of a landmark study that surprised even researchers.
The research was stopped early because the results were manifesting so conclusively. They showed that people who reduced their blood pressure to standards lower than previous ones reduced significantly their risk of dying from cardiovascular disease.
Public health officials had struggled to reverse the nearly 11 percent increase in the U.S. death rate from high blood pressure during the decade ending in 2015, Muntner said.
Under the tougher guidelines for blood pressure, first published in late 2017, the percentage of U.S. adults with high blood pressure jumped from 32 percent to nearly 46 percent
“Before this guideline, if your blood pressure was at 130, you weren’t supposed to do anything,” says cardiologist Kenneth Jamerson, an author of the high blood pressure guidelines.
“With the new [high blood pressure] guideline, we’re having patients do something about it,” he said.
Jamerson’s advises patients with hypertension to:
-Get a minimum of 30 minutes of physical activity five days a week.
-Follow the DASH diet, designed to lower blood pressure by reducing salt intake and increasing consumption of fresh produce, low-fat dairy, plus moderate amounts of whole grains, fish, poultry and nuts.
-Medication, as recommended by your physician, generally when patients have additional heart-disease risk factors.
High blood pressure creates excess strain and damage for the coronary arteries. Over time, they grow narrow from a buildup of fat, cholesterol and other substances.
It is a dangerous yet shockingly common condition with the potential to elevate your risk of heart disease and stroke.
The more stringent guidelines help physicians understand the need to up their focus on the condition. To make the task tougher, about half of the adults with hypertension don’t have it under control.
It’s a tricky condition to detect, because high blood pressure seldom has symptoms, earning it the macabre nickname, the silent killer.
The lack of detectable symptoms means that few people with high blood pressure diagnose themselves and consult a physician on their own.
All physicians, regardless of their speciality, are urged to remain alert to the condition. That means recommending that any patient with untreated hypertension consult a physician at once.
Dentists to the Rescue?
Even dentists get into the act. A routine check of blood pressure sometimes produces a reading high enough to shock even the patient.
“You’d be surprised how often it happens,” says Marcos Garcia, DDS, of Corpus Christi, Texas. He urges such patients to consult their physician.
Despite the ongoing need to identify people with hypertension, the new standards put pressure on doctors to redouble their efforts.
The truncated study that showed the need to keep blood pressure lower than in the past was called the Systolic Blood Pressure Intervention Trial, or SPRINT.
SPRINT was as serious as it was ambitious, involving more than 9,000 people age 50 and up who had both systolic blood pressure (top number) of 130 or more and at least one known risk factor for heart disease.
The systolic reading describes the amount of pressure in arteries during contraction of the heart. The bottom number is the diastolic pressure, or the reading when a heart is between beats.
Researchers wondered if reducing people’s systolic reading to 130 or less would produce a better outcome than the old guideline of 140. They were on to something; participants with the lower readings cut their risk of cardiovascular events 25 percent and risk of death 27 percent.
The effect was so remarkable, researchers were compelled by ethics to halt the study early and publish right away, in an effort to begin saving lives immediately.
“Blood pressure guidelines are not updated at regular intervals,” explains Dr. Paul Conlin, an endocrinologist at Brigham and Women’s Hospital in Boston. “Instead, they are changed when sufficient new evidence suggests the old ones weren’t accurate or relevant anymore.”
That’s exactly what happened when the results of the SPRINT study were released. “The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it, like heart attack and stroke — much earlier,” Conlin told Harvard Health Publishing.
Besides toughening blood-pressure numbers, doctors updated the guidelines in other ways. For one thing, they’ve done away with differentiating by age.
The same recommendations for blood pressure now apply to people younger or older than 65. That’s because the study looked at all patients, regardless of age, and kept them in one group.
Prehypertension Doesn’t Exist
The new rules left out or recast some categories of hypertension. Remember the classification of prehypertension? It used include people with a systolic blood pressure of 120 to 139, or a diastolic pressure of 80 to 89.
Prehypertension is longer used as a category. People whose readings used to put them in that group are now described as having either elevated pressure (systolic pressure 120 to 129), or stage 1 hypertension (systolic pressure 130 to 139 or diastolic 80 to 89).
What’s more, a reading of 140/90 is now considered stage 2 hypertension. A reading above 180/120 is a hypertensive crisis, which is especially dangerous if accompanied by chest pain, shortness of breath, back pain, numbness or weakness, change in vision, or difficulty speaking.
If you were previously diagnosed with high blood pressure, the new guidelines don’t affect you much, Conlin says.
The tougher reality to swallow is that many men age 65 and older suddenly find themselves diagnosed with elevated blood pressure, since the new normal is a whopping 20 points lower in the old guidelinesthan before.
But people in this predicament don’t necessarily need to start popping pills.
“They should consult with their doctor about first adjusting lifestyle habits, such as getting more exercise, losing weight, and following a heart-healthy diet like the DASH or Mediterranean diet,” Conlin says.
Medications to lower your blood pressure in Stage 1 hypertension are recommended only if you’ve already had a heart attack or stroke or if your 10-year risk of a heart attack is higher than 10 percent. (Calculate your risk at www.cvriskcalculator.com.) For others with Stage 1 hypertension, lifestyle changes alone are recommended
Another change recommended by researchers is to modernize the now-outdated protocol used in most physicians’ offices for measuring blood pressure. The old standards also persist on the internet.
Readings obtained with an automated device, which operates without a clinician in the room, were found to be consistently lower than with techniques involving a clinician. They also more closely match out-of-office readings.
“Our current approach to routine office blood-pressure measurement should not be used to implement the targets recommended in this guideline,” cautioned Dr. Michael Lefevre, University of Missouri School of Medicine, jin an editorial in American Family Physician.
Clinicians are now advised to follow certain guidelines when measuring blood pressure in their offices:
—Before the appointment, advise the patient to avoid caffeine, exercise and smoking for at least 30 minutes beforehand.
—Make sure the patient’s bladder has been emptied.
—Ask the patient to relax and sit in a chair for at least five minutes, feet on the floor and back supported.
—Both of you should refrain from talking during the rest period and measurement.
—The area where the cuff will be attached should be free of clothing.
—Use the correct cuff size.
—Support the patient’s arm.
—Position the middle of the cuff on the patient’s upper arm at the midpoint of the sternum.
—Wait one to two minutes between repeated measurement
—Take the average of at least two measurements.
The reason hypertension can be so harmful is that it involves a higher-than-normal force of blood constantly pushing against the walls of the arteries, which carry blood from your heart to other parts of your body.
Blood pressure normally rises and falls throughout the day. But if it stays high for a long time, that’s when it can damage your heart and other organs, including your brain. It can also lead to health problems, like heart disease and stroke, the top causes of death in the United States.
The stress and damage from high blood pressure cause the pathway inside the arteries to narrow from a buildup of fat, cholesterol and other substances. The resulting decrease in blood flow to the heart can produce:
—Heart failure, when your heart can’t pump enough oxygen-rich blood to your other organs.
—Heart attack, when the blood supply to your heart is blocked, causing heart muscle to die from lack of oxygen.
If that weren’t serious enough, hypertension can cause a stroke when arteries supplying blood to the brain burst or become blocked. Brain cells die from lack of oxygen during a stroke, leading to disabilities in speech, movement, and other basic activities. A stroke can also kill you.
Coddle the Kidneys
Your kidneys are put at risk by high blood pressure, too. About one out of five adults with hypertension has chronic kidney disease.
That may sound like unappealing news. But there’s good news, too. High blood pressure can be controlled. Many people can do this through changes to their lifestyle. Medication is available, too.
To boil it down to one sentence, when you lower your blood pressure, you lower your risk of heart attack, heart failure, stroke and chronic kidney disease. Put another way, there’s a lot at stake.
Lifestyle changes that can help control your blood pressure include:
—Eating a healthy diet that’s low in salt; total fat; saturated fat and cholesterol, and high in fresh fruits and vegetables.
—Be active. For starters, try a brisk, 10-minute walk, three times a day, five days a week.
—Do not smoke. This is a biggie. If you smoke, quit as soon as possible. There are a number of different approaches for quitting. Some are at smokefree.gov,
—Maintain a healthy weight.
—Limit alcohol use.
—Prevent or treat diabetes, which would compound the effects of hypertension.
—Continue to get your blood pressure checked regularly.
Anyone, including children, can develop high blood pressure. The condition costs the US some $46 billion in health care services, medications, and missed days of work each year.
The CDC runs several heart-disease and stroke-prevention programs that help people learn to prevent and control high blood pressure. The CDC also funnels funds to state programs and maintains a detailed national plan to reduce heart disease.
Other ways to reduce blood pressure include:
—Cutting back on sugar and refined carbohydrates, a change that will help you lower blood pressure and lose weight.
—Passing the bananas around and dumping the salt shaker. The increased potassium reduces the effects of salt on your system by causing more sodium to be released in urine. People with kidney disease should check with their doctor before increasing potassium.
—Reducing salt intake using the DASH diet. You know, Dietary Approaches to Stop Hypertension. The eating plan focuses on low-sodium foods, fruits and vegetables, low-fat dairy, whole grains, fish, poultry, beans, and cutting back on sweets and red meat. Pay attention to labels. Sodium at or below 5 percent is considered low. Anything at or above 20 percent is high.
—Quitting cigarettes. I know, easier said than done. But the harmful effects of high blood pressure can be a major reason for quitting. The short-term effect of smoking is to temporarily increase your blood pressure and heart rate. Then, over the long haul, chemicals contained in tobacco can actually damage the walls of your blood vessels, which causes inflammation and narrows your arteries.
—Letting go of stress. This will lower your blood pressure and contribute to your overall health. Experiment till you find the best approach for your life right now. Listening to music each day has been shown to reduce blood pressure. Some other ideas are deep breathing, walking, reading a book, or watching an hysterically funny movie
—Practicing meditation or yoga or both. Meditation has long been used and studied as a way of lowering stress.
—Yoga that includes breath control, postures and meditation has been found to be nearly twice as effective as yoga that doesn’t include all three.
—Taking dark chocolate, for medicinal purposes. Go for at least 60 percent cacao, and one or two squares a day. It could help reduce blood pressure and inflammation. Scientists theorize the flavonoids help widen your blood vessels.
—Giving healing herbs a try. Some have been associated with reducing blood pressured, though more peer-reviewed research is needed to identify dosage, as well as the component of the herbs that cause the healing effect. Make sure they don’t interfere with the effects of prescription medicine
Herbs and other plants that are used around the world to lower blood pressure include:
black bean (Castanospermum australe)
cat’s claw (Uncaria rhynchophylla)
Chinese hawthorn (Crataegus pinnatifida)
giant dodder (Cuscuta reflexa)
Indian plantago (blond psyllium)
maritime pine bark (Pinus pinaster)
river lily (Crinum glaucum)
roselle (Hibiscus sabdariffa)
tomato extract (Lycopersicon esculentum)
tea (Camellia sinensis), especially green tea and oolong tea
umbrella tree bark (Musanga cecropioides)
Other DIY ways to put a lid on high blood pressure include:
—Getting good, restful sleep. It’s typical for your blood pressure to go down when you sleep, so if you sleep poorly, it can affect your readings. Sleep deprivation is associated with increased risk of high blood pressure. Regularly sleeping less than seven hours or more than nine hours a night ups your risk of high blood pressure.
—Ingesting garlic or taking garlic-extract supplements. Both are used to to control blood pressure. One study concluded that a time-release garlic extract might work better than regular powder tablets. Fresh garlic or garlic extract are also both widely used.
—Getting a good amount of healthy, high-protein foods. A long-term study found that people who ate an average of 100 grams of protein reduced their risk of high blood pressure by 40 percent. Combining high protein with regular fiber led to a reducing the risk by up to 60 percent. But take care: If you have kidney disease, think twice about eating a high-protein diet.
—If you’re avoiding meat or seafood, there are still plenty of foods high in protein, including beans and legumes, nuts or nut butters, eggs, yogurt, whey protein, cottage cheese and other cheeses. You should still have an easy time consuming 100 grams of protein a day.
—Vegetarians may need to keep a closer watch on protein grams but shouldn’t find it difficult to get enough. A half-cup serving of most types of beans will give you up to 10 grams of protein, and two tablespoons of peanut butter provide 8 grams.
Beyond reshaping your diet, you might want to try taking nutritional supplements associated with lowering blood pressure, one at a time, and maintaining a record of whether they work for you.
Some good candidates are:
—Omega-3 polyunsaturated fatty acid. Adding omega-3 polyunsaturated fatty acids or fish oil to your diet can have many benefits. An analysis of the relationship between fish oil and blood pressure found a mean blood pressure reduction in those with high blood pressure of 4.5 mm Hg systolic and 3.0 mm Hg diastolic (35).
—Magnesium. Higher blood pressure can be related to magnesium deficiency. An analysis of existing research found the magnesium supplements had a slight association with a reduction in blood pressure.
—Coenzyme Q10. A handful of small studies showed that the antioxidant CoQ10 lowered blood pressure. The results weren’t exactly conclusive, but it might be worth trying.
—Citrulline. *Oral L-citrulline can help produce L-arginine in the body, a building block of protein, which may lower blood pressure
If you drink alcohol, consider tracking how much and how often you indulge. Alcohol can increase the blood pressure of even a healthy person.
If you drink in moderation, you’re good to go. Moderate drinking is up to one drink a day for women and up to two drinks for men. A standard drink is one 12-ounce beer, 5 ounces of wine, or 1-½ ounces of liquor.
Some experts say it’s a good idea to cut caffeine, which increases your blood pressure. But the effect is temporary, and the impact varies from one person to the next.
Don’t shy away from taking prescribed medication, if your high blood pressure does not respond to lifestyle changes. Just be prepared that it can take awhile to determine the right combination of drugs for an individual.
The good news is that medications to lower blood pressure are effective. They’ll improve your chances of avoiding cardiovascular disease, especially if you have other risk factors.