The nation’s top heart experts this week lowered the new designation for high blood pressure, a sweeping decision that means nearly half of all Americans could now fall into that category and be at higher risk for heart problems. The change lowers the threshold for having hypertension from 140/90 to 130/80.
Dr. Thomas Barringer didn’t waste any time reacting. The next morning he started adjusting his treatment to patients, including Carl Johnson, whose average reading has been 131/70.
"According to the new guidelines, he’s not at goal,” said Barringer, “Co-Medical Director, Heart & Vascular Institute – Prevention.” His systolic pressure (the top number) should be below 130. I told him, ‘If I’d seen you yesterday, I would have said this is fine. Now that we have new guidelines, we need to increase your blood pressure medicine a little bit.’”
Barringer said he was quick to embrace the new guidelines based on the National Institutes of Health 2015 SPRINT study, which found that lowering blood pressure targets “greatly reduces cardiovascular complications and deaths” in older adults.
"I think it will make a big impact on the rate of heart attack and stroke” by having doctors intervene sooner, he said.
According to the American Heart Association: “The change means 46 percent of U.S. adults are identified as having high blood pressure, compared with 32 percent under the previous definition. A blood pressure of less than 120/80 still will be considered normal, but levels at or above that, to 129, will be called ‘elevated.’”
When it comes to the new guidelines, “the first thing people should do is start monitoring their blood pressure" under the direction of their primary care physician, Barringer said. He also noted that blood pressure fluctuates throughout the day and that you shouldn’t panic over high numbers at a single reading. Again, he said, work closely with your primary care physician.
For patients who don’t have other risk factors for heart disease and stroke — family history, cholesterol levels and smoking — Barringer said he won’t prescribe medication until they register 140/90. But for patients with a 10-year risk for having a cardiovascular event of at least 10 percent, he said he would prescribe medication.
Lots of medications available
With 30 to 40 blood pressure medications now available, patients typically don’t need to worry about potential side effects, he said. “We have so many good options that if a patient has side effects with one drug, we can use another one …. We can control blood pressure in just about everyone without side effects.”
Barringer added: “Usually, the first line of treatment for patients involves diet, weight loss and exercise. Lowering salt intake with a diet such as the DASH diet (Dietary Approach to Stop Hypertension) is effective at lowering blood pressure. Losing weight can also help people lower their blood pressure.”
Johnson, 71, the patient whose medication was adjusted by Barringer based on the new findings, came in for his annual checkup and has been on blood pressure medication since he was 45. His father died of a massive heart attack at 51, so Johnson is at an elevated risk himself.
“It’s just part of good health” Johnson said of the adjustment. “I exercise and do exactly what they tell me. So far, things are going well.” He also noted that he was taking steps — lots of steps — to stay healthy.
“I’m meticulous about exercise. I’m on a treadmill five days a week for almost 4 miles,” said Johnson, a retired fundraiser and financial planner for UNC Charlotte. “My doctor thinks that’s as important as anything.”
How's your heart health?
Novant Health has launched a communitywide campaign called the 10,000 Healthy Hearts Challenge with a goal to educate 10,000 people about their heart health by 2018.
Take the online heart health risk assessment, which analyzes cardiovascular risk factors, such as blood pressure, cigarette smoking, diabetes and body mass index. Then, tag five friends on social media using #NHHealthyHearts to spread the word. Once you accept the challenge, look for helpful wellness tips, recipe ideas and stress management reminders sent to your inbox to manage your heart health.