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New High Blood Pressure Guidelines

The National Heart, Lung, and Blood Institute (NHLBI), an arm of the National Institutes of Health, has released new clinical practice guidelines for the prevention, detection, and treatment of high blood pressure. These guidelines feature altered blood pressure categories, including a new "pre-hypertension" level.

Millions of people who previously were told that their blood pressure levels were fine, are now being said to have a condition called "pre-hypertension," and should do something about it. The new category, which encompasses about 45 million Americans includes those persons whose blood pressure is 120 to 139 millimeters of mercury systolic or 80 to 90 diastolic--120/80 (12/8 in many European countries).

According to the NHLBI the new recommendations bring together results from more than 30 clinical studies worldwide, studies that showed that artery damage could begin even at blood pressure levels that were previously thought to be normal and optimal. The risk of heart disease and stroke starts to rise when readings are as low as 115/75 and doubles for each increase of 20/10 millimeters of mercury. The harm starts long before people get treatment. The new report from a special committee of the National High Blood Pressure Education Program (NHGPEP)1 defines normal blood pressure as a reading below 120/80. High blood pressure is considered as any reading above 140/90. The first number is the pressure in the arteries when the heart is contracting; the bottom number is the pressure when it is at rest between beats.

In the United States alone one in four adults have high blood pressure, 50 percent are being treated for it and it is under control in less than a third of them. Worldwide, a billion people suffer from hypertension.

Hypertension sufferers exhibit no symptoms and one-third of people who have it, don't know it. High blood pressure injures the arteries and causes them to stiffen, which in turn increases the pressure even more. Blood pressure tends to increase steadily with age, and the new report shows that even people whose readings are normal at age 55 have a 90 percent chance of developing high blood pressure at a later date.

The report suggests that better control of blood pressure could drastically reduce the number of deaths from cardiovascular disease, stroke and kidney disease. Lowering high blood pressure may also reduce the advance of dementia and cognitive impairment, which is more common in people who suffer from hypertension.

According to the report, progress in controlling hypertension has been linked with a 35 to 40 percent reduction in the incidence of stroke, a 20 to 25 percent reductions in heart attacks,

According to the Chair of the Committee that produced the new guidelines, the findings of the studies upon which these recommendations are based were "consistent in demonstrating the critical importance of lowering blood pressure, regardless of age, gender, race, or socio-economic status." The data allowed the committee to create a set of recommendations that are easier to follow than past guidelines.

What are the new recommendations? The report advises those with "pre-hypertension" (120-139/80-89) to make any needed lifestyle changes. These include losing excess weight, becoming physically active, limiting alcoholic beverages, and following a heart-healthy diet (rich in vegetables, fruit and nonfat dairy products), including reducing the consumption of salt and other forms of sodium. Studies have shown that this kind of diet can significantly lower blood pressure and that decreases are often comparable to those achieved with medication. The report also recommends that people quit smoking.

Doctors are urged to take high blood pressure more seriously and treat it more aggressively, often with more than one drug.

To raise awareness about the dangers of high blood pressure, NHLBI is developing special Web pages and educational materials for healthcare professionals, patients, and the public. An updates "Your Guide To Lowering High Blood Pressure" web page can be found at www.nhbli.nih.gov. The guidelines and related information are available at http://www.nhlbi.nih.gov/guidelines/hypertension/index.htm.

1- The special committee of the BHBPEP represents 46 professional, voluntary, and Federal organizations, and reviewed by 33 national hypertension experts and policy leaders.


Dolores C., Health Issues

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