Hypertension. That’s a word more of us are going to have rolling across our lips.

Because according to the American Heart Association and the American College of Cardiology, half of us are so afflicted. We have high blood pressure- and I’m not talking about old farts like me, but ALL of us. Appropriately, these new findings and guidelines were published in the journal called Hypertension.

Back when I was being trained, hypertension was defined as a condition when our blood pressure was 140 over 90 (which is written 140/90). The top number is our systolic blood pressure; the bottom diastolic. Systole is when our heart is pumping blood around our bodies. Diastole is when the heart is resting- in other words, the standing pressure in our blood vessels.

Now, the guidelines have recognized that blood pressures over 120 mm Hg incur health risks- kidney failure, heart attack, and/or stroke. This elevated blood pressure condition suggests intervention is required. Once blood pressures have reached 130/80, subjects seem to have significant health risks, according to these new reports. As such, folks manifesting such blood pressure will be termed to be in Stage 1. When the pressures are further elevated to 140/90, it is termed Stage 2 hypertension.

Now, for an alternative thought.  These new recommendations emanate from a 2015 published study from the SPRINT group (New England Journal of Medicine).  That was a study of patients over the age of 50, which split the groups into those attaining a target systolic pressure of 140 and another with a systolic pressure of 120.  The lower systolic pressure resulted in those patients demonstrating a 25% reduction in cardiovascular trauma.

Sounds impressive, right?  25%!  That’s a big number. Well, how about if I tell you that the higher pressure group experienced a cardiovascular event in 8% of the population- while the lower pressure group manifested a 6% event threshold over four years of study.  It gets better-because  the entire SPRINT group had higher-than-average risk for cardiovascular events.

Let’s get deeper still into the discussion.  Blood pressure measurements require the patient to be at rest and not stressed.    That typically means 5 minutes of quiet rest with no medical staff present.  And, the SPRINT test averaged THREE of those measurements.     If you were a patient of my physician, you’d be given 20 seconds of rest, with the nurse at your side and a single measurement.  (As an example, my morning blood pressure results are 123/80 routinely.  In his office, my measurements are 138/89.   Not only because of stress, but because I have just finished a breathing test, and then get my blood pressure taken.)

But the good thing about these new recommendations is that given that it plans to intervene in many younger folks’ lives, the prescription for elevated blood pressure conditions will no longer resort immediately to a drug regime.  (By the way, too much of such medicine can lower our blood pressure dramatically- which can mean we faint or fall.  That’s happened to me, too!)

Nope. Not as a result of these new recommendations.  Instead, we are going to be counseled to exercise. We will need to eat healthier. We need to lose some weight. (This is exactly what lifestyle modifications are.  And, they are certainly valid for our lethargic, obese citizenry.) And, we need to make these changes before things get worse, before folks get older and those lifestyle changes are harder to achieve- and, even when achieved,  manifest fewer of those benefits..

If after 90 days of lifestyle modification, those manifesting Type 1 hypertension fail to lower their blood pressures, pharmaceutical intervention- and continued lifestyle modification- will be the course of action. The drugs of course include calcium channel blockers, diuretics, and ACE inhibitors. (The good thing is all these are available in generic [i.e., cheaper] versions.)

We need to recognize that many lifestyle modifications have a poor chance of improving patient health. (Nearly half of Americans who were found to be hypertensive and effected lifestyle modifications did not reduce their blood pressure to a significant extent.) But, that doesn’t mean these changes shouldn’t be our first response to the condition. Especially, since most of those subjects who didn’t improve were among our older populations.

After all, there has been an explosion in the numbers of folks manifesting kidney failure.  Between diabetes and hypertension- both of which are precursors (and related to obesity, to boot) to kidney failure, those lifestyle changes can yield dramatic improvements for those under the age of 50.  Of course, I admit that I’ve made lifestyle changes AFTER turning 50 (I’ve been swimming about a mile five times a week and have been riding my bike for about 20 miles a week for more than a decade).  And, like many of our older citizens have found, those  changes have not manifested in the health results I desired.  (Yeah, neither was my doctor happy!)

That prescription for six miles of walking a week (you can find more on this topic by typing miles in the index above) is going to become a heck of a lot more widespread, given these new guidelines, though.

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