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New Blood Pressure Guidelines

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This is a well researched topic with many experts on the review panel. The whole study can be found on line. They are not saying 140 or 150 isn't hypertension, but that it may not need to be treated with medication. It should not give the false impression that one should not keep monitoring BP. In addition, the recommendations include that there are certain groups of people over 60 who should not consider 150 to be a safe range.

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Sounds like they are being a bit more realistic about medicating which is always good

Obamacare will love this report and will surely embrace it.

I expect that the over 6 million newly insured will be very interested since many likely haven't seen a doctor in awhile.

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Thank you for sharing this article. The information certainly merits careful consideration and used on a case-by-case basis. This information should certainly be discussed when setting your health goals and lifestyle planning with your healthcare provider.

Here is some basic and some in depth information I thought may be helpful as well.

What is high blood pressure? — High blood pressure is a condition that puts you at risk for heart attack, stroke, and kidney disease. It does not usually cause symptoms. But it can be serious.

When your doctor or nurse tells you your blood pressure, he or she will say 2 numbers. For instance, your doctor or nurse might say that your blood pressure is “140 over 90.” The top number is the pressure inside your arteries when your heart is contracting. The bottom number is the pressure inside your arteries when your heart is relaxed.

This Table shows how doctors and nurses define high and normal blood pressure

Definition of normal and high blood pressure
  • Level Top number Bottom number High 140 or above 90 or above
  • Prehypertension 120 to 139 80 to 89
  • Normal 119 or below 79 or below
"Prehypertension" is a term doctor or nurses use as a warning. People with prehypertension do not yet have high blood pressure. But their blood pressure is not as low as it should be for good health.

How can I lower my blood pressure? — If your doctor or nurse has prescribed blood pressure medicine, the most important thing you can do is to take it. If it causes side effects, do not just stop taking it. Instead, talk to your doctor or nurse about the problems it causes. He or she might be able to lower your dose or switch you to another medicine. If cost is a problem, mention that too. He or she might be able to put you on a less expensive medicine. Taking your blood pressure medicine can keep you from having a heart attack or stroke, and it can save your life!

Can I do anything on my own? — You have a lot of control over your blood pressure. To lower it:

  • Lose weight (if you are overweight)
  • Choose a diet low in fat and rich in fruits, vegetables, and low-fat dairy products
  • Reduce the amount of salt you eat
  • Do something active for at least 30 minutes a day on most days of the week
  • Cut down on alcohol (if you drink more than 2 alcoholic drinks per day)

It’s also a good idea to get a home blood pressure meter. People who check their own blood pressure at home do better at keeping it low and can sometimes even reduce the amount of medicine they take.

RECOMMENDATIONS — Using the above definitions from the Joint National Committee (JNC), European Societies of Hypertension and Cardiology(ESH/ESC), and American and International Societies of Hypertension (ASH/ISH), the following general approach can be used to determine which patients with hypertension require antihypertensive therapy . This approach assumes accurate measurement of the blood pressure .

All patients should undergo appropriate lifestyle (nonpharmacologic) modification (THIS IS USUALLY THE HARD PART). In the absence of evidence for hypertensive target organ damage, the following decisions about antihypertensive medications are generally not made until there has been an adequate trial of nonpharmacologic therapy. However, if there is evidence for target organ damage, decisions on antihypertensive medications may be warranted earlier.

In the absence of end-organ damage, a patient should not be labeled as having hypertension unless the blood pressure is persistently elevated after three to six visits over a several month period. In one study, for example, there was a mean 15/7 reduction in blood pressure in untreated patients between the first and third visits to a new physician . This difference has prognostic importance. The Medical Research Council Mild Hypertension Trial found a close correlation between cardiovascular risk and the systolic pressure measured three months after entry into the trial . In contrast, a transient increase in systolic pressure at entry due to a white coat response was not associated with increased risk. During the initial evaluation period before a therapeutic decision is made, patients should also be encouraged to measure their blood pressure at home or work.

Antihypertensive medications should generally be begun if the systolic pressure is persistently ≥140 mmHg (in patients younger than 60 years) and/orthe diastolic pressure is persistently ≥90 mmHg in the office and at home, despite attempted nonpharmacologic therapy. The same applies to patients 60 to 79 years, although such patients are somewhat more likely to develop side effects from therapy. In patients 80 years and older, antihypertensive medications should generally be started if the systolic pressure is persistently ≥140 mmHg and/or the diastolic pressure is persistently ≥90 mmHg.

Thus, systolic and diastolic hypertension, isolated systolic hypertension, and isolated diastolic hypertension all should be treated. Isolated diastolic hypertension is associated with increased cardiovascular risk, but there are no treatment trials to prove benefit from antihypertensive therapy.

Starting with two drugs may be considered in patients with a baseline blood pressure more than 20/10 mmHg above goal. This strategy may increase the likelihood that target blood pressures are achieved in a reasonable time period, but should be used cautiously in patients at increased risk for orthostatic hypotension (such as diabetics and the elderly).

In some patients with proteinuric chronic kidney disease or known cardiovascular disease, antihypertensive therapy may be indicated when the systolic pressure is persistently above 130 mmHg and/or the diastolic pressure is above 80 mmHg . The benefit of such blood pressure lowering in patients with chronic kidney disease is probably limited to patients excreting more than 0.5 to 1 g of protein per day.

Patients with office hypertension, normal values at home, and no evidence of end-organ damage should undergo ambulatory blood pressure monitoring to see whether they are truly hypertensive.

On the other hand, 5 to 20 percent of patients with normal office readings have been found to have elevated out-of-the office readings by 24 hour automatic ambulatory blood pressure monitoring . These patients with "masked" hypertension appear to have an increased cardiovascular risk similar to those with elevated office and ambulatory readings .

In a number of conditions (eg, heart failure, post-myocardial infarction), antihypertensive drugs are given to improve survival, independent of the blood pressure . These uses are discussed separately in the appropriate topic reviews.

The importance of other risk factors on both cardiovascular risk and the likelihood of a beneficial response to antihypertensive therapy should not be underestimated . In the MRC trial, for example, the number of patients with mild hypertension who had to be treated for five years to prevent one cardiovascular complication was 262 in the absence of any risk factors but only four in high-risk patients who smoked, were older than 55, and had a systolic pressure above 160 mmHg .

Furthermore, cessation of smoking alone rapidly decreases coronary risk by approximately 35 to 40 percent, a benefit that is independent of the duration of smoking .

Prehypertension — Patients with prehypertension (systolic 120 to 139 mmHg and/or diastolic 80 to 89 mmHg), but without diabetes, chronic kidney disease, or cardiovascular disease are treated with nonpharmacologic therapies such as weight reduction, sodium restriction, and avoidance of excess alcohol. They should also have their blood pressure measured at least annually, or more frequently if home monitoring is available, since they are at significant risk of developing hypertension over time.

Hope this helps answer some questions and guide your healthcare with your healthcare provider.

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Dr. S,

Your posting was informative and will probably help people understand more about hypertension. One comment though,I would suggest you not discuss " a nurse prescribing medication or changing dosage". I think your reference probably was speaking to nurse practioners in US who have some prescribing privileges. Nurses here in Mexico ( if they are real nurses, since nurse aides etc are called nurses) should not be prescribing. It could be very dangerous if they did. It would not be appropriate for expat nurses either.

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Stroke Rounds: Prehypertensives at Greater Risk of Stroke

Published: Mar 12, 2014


By Todd Neale, Senior Staff Writer, MedPage Today

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco






Action Points

  • Even blood pressure in the lower prehypertensive range (120-139/80-89 mm Hg) appears to confer a significant risk for stroke.
  • Note that the authors recommend lifestyle interventions as the primary treatment for patients with pre-hypertension and that high-risk subpopulations with prehypertension should be selected for future trials of antihypertensive therapy.

Even blood pressure in the lower prehypertensive range appears to confer a significant risk for stroke, a meta-analysis showed.

Compared with a blood pressure of less than 120/80 mm Hg, individuals with a prehypertensive reading of 120-139/80-89 mm Hg had a 66% greater risk of stroke during follow-up (RR 1.66, 95% CI 1.51-1.81), according to Dingli Xu, MD, ofSouthern Medical University in Guangzhou, China, and colleagues.

The relationship was stronger for individuals in the top half of that prehypertensive range (RR 1.95, 95% CI 1.73-2.21), but it was still significant even at in the bottom half (RR 1.44, 95% CI 1.27-1.63), the researchers reported online inNeurology.

"This is a very important article," Howard Weintraub, MD, of NYU Langone Medical Center, told MedPage Today. "It validates what had been a growing concern of the gradient of risk in hypertension."

"This should offer motivation to watch blood pressure more carefully and encourage lifestyle modification to allow patients to attain levels that are closer to 120 mm Hg, particularly in those with blood pressures that are greater than 130 mm Hg, where the risk of stroke was greatest," said Weintraub, who was not involved in the study. "However, use of medication can still be considered, especially when there are other risk factors that could amplify the possibility of stroke."

William White, MD, of the University of Connecticut School of Medicine in Farmington, cautioned against using the findings as a guide to how low blood pressure should be brought in patients with readings in the hypertensive range.

"Of course, as in any cohort/observational analysis, the fact that stroke risk increases at levels of systolic blood pressure of 120 to 139 mmHg versus less than 120 mm Hg does not mean that patients with hypertension should be treated to levels that low as there is little evidence to support doing that," said White, who is president of the American Society of Hypertension. "Hence, the general consensus that systolic blood pressures should be lowered to less than 140 mm Hg in patients with hypertension."

The concept of prehypertension has been controversial since it was introduced in 2003 by the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), and the evidence regarding a relationship with stroke has been mixed.

A previous meta-analysis showed an overall association between prehypertension and a greater risk of stroke, although it appeared to be confined to blood pressure readings at thehigher end of the prehypertensive range.

The new meta-analysis cast a wider net for studies, however, and the 19 total studies (with 762,393 participants) included seven that were not used in the prior meta-analysis. Most of the studies in the current analysis (13) were conducted in Asia, and the remaining six were conducted in the U.S. and Europe. The rate of prehypertension ranged from 25.2% to 54.2%.

The higher stroke risk seen across the prehypertensive range was generally consistent in various subgroups, which "[reaffirms] the importance of the definition of 'prehypertension' rather than being 'normal' for individuals with blood pressure of 120-139/80-89 mm Hg," Xu and colleagues wrote.

"Considering the high incidence of prehypertension, up to 30% to 50%, successful intervention in this large population could have a major public health impact," they wrote, noting that a prior meta-analysis showed that antihypertensive therapy decreases stroke risk in patients with prehypertension.

They added, however, that lifestyle interventions should be recommended as "the mainstay treatment" for patients with prehypertension and that high-risk subpopulations with prehypertension -- such as those with other cardiovascular risk factors -- should be selected for future trials of antihypertensive therapy.

They acknowledged some limitations of their analysis, including the lack of patient-level data, the use of a blood pressure measurement from a single day at baseline to define prehypertension in most of the studies, and the lack of an assessment of blood pressure variability.

Xu disclosed relationships the Natural Science Foundation of Guangdong Province, Guangdong Provincial Science and Technology projects, Guangzhou City Science and Technology projects, and the National Natural Science Foundation of China. The other study authors disclosed relevant relationships with the Health Ministry of Guangdong province, the Scientific Research Fund of Foshan, and the Cardiovascular Medicine Research Fund of Guangdong.

From the American Heart Association:

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I'm all in favor of people doing what they can in lifestyle changes to lower their blood pressure. Good plan for health and longevity.

However, before taking any drug to lower it, I strongly suggest they spend some quality time with Senor Google to learn the side effects of taking such drugs. The same with any prescribed drugs. There is no free lunch.

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