Hypertension 2018 – What’s new? Part I
A Happy New Year to all of you. Hope you have resolved to adopt a healthy lifestyle even if it means foregoing some of your favorite desserts and cutting down the time you spend in front of the computer and TV. In addition, you need to pay attention to your own health-related parameters and numbers. As a first step, go and check your blood pressure (BP). Even if you don’t have your own portable machine, nearly every pharmacy in Florida has a BP recording station that’s free.
In our community clinic, every examination room is fitted with an electronic monitor with touch screen where important questions and answers about health matters pop up for waiting patients to read and interact. When I am ready to see a new patient, especially with hypertension, I direct him/her to a specific question on the screen, “What’s silent killer?” Well, most of them get it wrong. The right answer is, of course, “Hypertension (HBP).”
Why are we discussing this topic again since it was already dealt with a few years ago in this same column? The ACC / AHA (American College of Cardiology/ American Heart Association) has released new guidelines and new threshold for us to follow. Till now, the consensus has been an ideal goal for BP was systolic (SBP) less than 140 and diastolic (DBP) less than 90 mm of Hg for the general population with HBP and less than 130/80 for those with diabetes mellitus, chronic renal diseases and cardiovascular conditions. Now, there are new thresholds that we need to be aware of.
HBP, the world’s most common and modifiable cardiovascular risk factor, affects nearly 100 million or more Americans and over a billion people worldwide. The incidence is steadily increasing and sooner or later most of us will develop the condition, especially as we get older, unless we actively take steps to prevent it. Why do we worry about HBP and why the nickname ‘silent killer?’ Often the patients with HBP have no symptoms from the disease till he or she suffers from a major complication. “Hypertension is the world’s greatest risk factor for cardiovascular and renal diseases, strokes, death and disability,” according to the World Health Organization.
About 25 percent of adult Americans and even more globally are living with the disease and sadly, many don’t even know it. The recent SPRINT study results, well publicized in the media, suggest, “Intensive management of systolic BP (SBP) to a target of <120 mm Hg reduced the rates of complications of HBP by 30 percent and lowered the risk of death by almost 25 percent compared to the previous recommendation of a systolic BP target of <140 mm Hg. Hence, the leading heart-health experts tightened the guidelines for high blood pressure.
The 2017 ACC/AHA guidelines propose more aggressive thresholds and goals for treatment relative to prior guidelines. The new threshold for hypertension is a reading of 130/80 and above. The new guidelines eliminate the category of pre-hypertension that was considered 120 -139/ 80-89. Instead the new categories are:
Optimal BP: is now regarded as below 120/80.
Elevated: when readings are consistently ranging from 120-129 systolic and less than 80 mm Hg diastolic. People with elevated blood pressure are likely to develop high blood pressure in the future unless steps are taken to control it.
Hypertension Stage 1; when blood pressure is consistently ranging from 130-139 systolic or 80-89 mm Hg diastolic. At this stage, in addition to lifestyle changes blood pressure medications may be necessary.
Hypertension Stage 2: when blood pressure is consistently ranging at levels of 140/90 mm Hg or higher and would need a combination of blood pressure medications along with lifestyle changes for good control.
Hypertensive crisis: This is when the blood pressure exceeds 180/120 and you develop symptoms suggestive of organ damage like angina, shortness of breath, change in vision, speech difficulties, etc. This requires close medical attention, so contact your doctor immediately.
To be concluded …