New Goals For Blood Pressure Control

Well it’s happened.  For the last 6 months I’ve been warning my patients that the powers-that-be are going to be tightening up the goals for blood pressure control.  This week the American Heart Association, the American College of Cardiologists and a number of other professional organizations released new blood pressure control guidelines.

Why now?  For years the definition of hypertension has been a blood pressure over 140/90 for patients under 60 years of age, and over 150/90 for patients 60 and over.

There have been a number of new studies published showing that patients with blood pressure over 130/80 are at higher risk for heart attack, stroke and kidney disease due to the wear-and-tear of elevated pressures on the circulatory system. Our hearts and blood vessels and kidneys were not designed to deal with elevated blood pressures for long periods of time.

My cardiology colleagues hate when I compare the circulatory system to a water pump and piping, but the analogy works.  Too much pressure and the pump wears out sooner.  Too much pressure and the pipes can fail.  In the case of the living tissues of the human circulatory system, too much pressure strains the pipes and the chronic injury heals as scarring which shows up as plaque.  Too much pressure and the delicate filters of the kidneys get damaged.

I’ve known for a long time our guidelines were wrong.  Any number of times I’ve had patients with “normal” blood pressure need an echocardiogram (heart ultrasound) for a murmur or some other problem.  When the echo is done the report mentions that the heart muscle is stiff (called diastolic dysfunction).  Why does the heart muscle get stiff?  From chronically working against too-high blood pressure.  I treat my patients with diastolic dysfunction with blood pressure medication, regardless of the numbers I get with the BP meter.  My goal is typically to lower the top number and bottom number both by 10 points.

Why treat patients with diastolic dysfunction with blood pressure medication?  Because whatever the numbers, their heart is telling us that THE PRESSURE IS TOO HIGH.  The heart is working too hard, “lifting weights” like the big muscle-bound guys at the gym, and the heart muscle is too thick and stiff to function properly.

These new guidelines are actually not as aggressive as I expected.  The SPRINT trial, one of the primary drivers of the new guidelines, actually showed that controlling blood pressure below 120/80 saves lives from heart attacks and strokes and prevented the development of kidney disease.

Here is a picture graphic showing the new guidelines:

What are we supposed to do with patients whose blood pressures are considered “elevated” or “high?” We are SUPPOSED to start with lifestyle changes.  “Aggressive” lifestyle changes, in fact.  Yay!  That is right up my alley!  Unfortunately, many doctors are likely to skip the lifestyle change talk and move right to medications.

We cannot medicate away a bad lifestyle.  This is something I teach my students in no uncertain terms.  If a person wants to be healthy you MUST start with a healthy lifestyle.

A healthy lifestyle means avoiding smoking, excessive alcohol and other harmful substances.  It means eating more fresh whole colorful plant foods, whole grains, beans, nuts, seeds and healthy fats and avoiding or limiting animal foods like animal flesh, eggs and dairy.  A healthy lifestyle means drinking fresh clean water instead of soda and juice.  It means getting plenty of sleep, plenty of exercise and plenty of fresh air and time in nature.  A healthy lifestyle means doing what you can to minimize toxic stress and your exposure to negative, toxic people.  Respecting your body, respecting your mind and respecting your spirit are integral to health.

Supplements have their place as well.  I have patients for whom the only blood pressure “medication” needed is a magnesium supplement once or twice daily.  Fish oil can also help to reduce blood pressure especially in doses over 2000 mg daily.  Please reach out to me if you’d like more information on using supplements to help with elevated blood pressure.

If the next time you’re at the doctor you’re told your blood pressure is too high, please make sure to discuss diet, exercise, other lifestyle changes, weight loss and supplements with your doctor.  If your blood pressure is over 150/90 you likely will need medication right away, but don’t give up on the lifestyle changes.  One of my favorite things to do is to take patients OFF of blood pressure meds!  It definitely happens often enough to keep me hoping 🙂

So these new guidelines mean we’re going to be prescribing more medications but also hopefully that we will be pushing harder on people to make healthier lifestyle choices.  Which ultimately will be good for us all.

QUESTION: Do you have high blood pressure?  Are you sure?  Do you think the next time you see your doctor you will be discussing your blood pressure?

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