I wanted to find a way to include the 1981 hit “Under Pressure” by Queen and David Bowie to help peak your interest in this topic, but unfortunately they didn’t teach social media techniques during grad school. Humor me and just imagine the “Mmm num ba de, Dum bum ba be, Doo buh dum ba beh beh.”
Hypertension, or high blood pressure, is likely something you have heard a lot about. Either a family member has it, you have heard about it on the news or social media, you may have even been diagnosed! If not, let me help break the "Silent Killer" down for you.
We call Hypertension the “Silent Killer” because a lot of times we find hypertension randomly during exams. Some people will have symptoms such as flushed face, headache, dizziness, or just overall feeling “off.” Others have no symptoms and will have vitals taken during an exam and be told, “your blood pressure is high.”
New American College of Cardiology (ACC) and American Heart Association (AHA) guidelines were published in 2017. This is the first comprehensive set published since 2003. These new guidelines eliminated the category of Pre-Hypertension that was previously used in other guidelines. The purpose of eliminating Pre-Hypertension is due to research finding some patients need to be treated with medication and lifestyle modifications sooner.
Previously, blood pressure was not treated until you had 2 consecutive blood pressure readings of 140/90 or greater. Now with the new guidelines, we are lowering our threshold of treatment to help provide better prevention of complications that can occur with lower BP readings over long periods of time. In my personal practice, I am now beginning treatment in more patients and at younger ages.
The new guidelines are expected to diagnose close to half the population in the US with hypertension, the majority of those diagnoses occurring in people under the age of 45. According to Paul K. Whelton, MB, MD, MSc, FACC, (who was lead author on the new guidelines), “You've already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure.” We as providers want to make our patients aware of their blood pressure sooner to help prevent other long-term complications. Sometimes this means medications but the majority of the time, it means having a discussion about needs for exercise and diet changes.
So now, let’s show you what the new guidelines look like. Blood pressure is now defined in these stages:
Stage 1 hypertension is when you will likely be started on medication. Along with medication, aim to increase your exercise regimen to getting 150 minutes of moderate intensity cardio per week (this can be walks, runs, fitness classes, dancing, whatever you enjoy), lower alcohol consumption, minimize added salt, focus on more whole foods (shop the perimeter of the grocery store) and get 7-8 hours of good restorative sleep per night.
Our goal as providers is not just to throw more medication at you, but try to start medication earlier at lower dosages while you are also working on long term lifestyle modifications. You may be able to come off of your medications with lifestyle modifications. Remember with lifestyle modifications, find something you enjoy doing for exercise and foods that provide nutrition that you enjoy eating. If you don’t enjoy it, you won’t sustain it!
By controlling hypertension, we can help limit your risk of long-standing complications like stroke, heart disease, kidney disease, and eye damage. If you are diagnosed with hypertension, be sure you buy a blood pressure cuff to check your blood pressure at home. If you don’t have symptoms when your blood pressure is elevated, it is even more important to keep a blood pressure log. I usually recommend an arm cuff that will store blood pressure readings individually (not just averages). When checking your blood pressure, sit with both feet flat on the floor, arm resting in lap or on table, breathe normally and don’t talk while the machine is reading your BP. Try checking blood pressure twice per day (morning and evening). If you notice your readings continuing to be 130/80 or greater, call your provider to come in to discuss either changes in medications or other options.
We could talk about hypertension for days! There are multiple classes of medications with different ways medications work, there are genetics that come into play and stress levels. Whatever questions you have, please never hesitate to ask your provider and have that conversation so you can understand your health and why certain treatments are prescribed.
Happy New Year everyone! Let’s have a great and low pressure 2021!
Kristen Allen, DNP, FNP-BC
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