New rules put pres­sure on Amer­i­cans’ lifestyle

The West Australian - - WORLD -

New guide­lines have low­ered the thresh­old for safe high blood pres­sure, adding 30 mil­lion Amer­i­cans to those who have the con­di­tion, which now plagues nearly half of US adults.

The mea­sure of high pres­sure, which for decades has been a top read­ing of at least 140 or a bot­tom one of 90, falls to 130 over 80 in ad­vice re­leased this week by a dozen med­i­cal groups.

The change means an additional 14 per cent of US adults have the prob­lem, but only an additional 2 per cent will need med­i­ca­tion right away — the rest will be ad­vised to try health­ier life­styles, which get much stronger em­pha­sis in the new ad­vice.

Poor di­ets, lack of ex­er­cise and other bad habits cause 90 per cent of high blood pres­sure.

“I have no doubt there will be con­tro­versy. I’m sure there will be peo­ple say­ing ‘we have a hard enough time get­ting to 140’,” Paul Whel­ton, a Tu­lane Univer­sity doc­tor who led the guide­lines panel, said.

But the risk for heart dis­ease, stroke and other prob­lems drops as blood pres­sure im­proves and the new ad­vice “is more hon­est” about how many peo­ple have a prob­lem, he said.

Cur­rently, only half of Amer­i­cans with high blood pres­sure have it un­der con­trol.

The up­per thresh­old for high blood pres­sure has been 140 since 1993. How­ever, ma­jor study two years ago found heart risks were much lower in peo­ple who aimed for 120.

Canada and Aus­tralia have low­ered their cut-off to that fig­ure. Europe is still at 140 but is due to re­vise its guid­ance next year.

For peo­ple aged over 65, the guide­lines undo a con­tro­ver­sial tweak made three years ago to re­lax stan­dards and not start medicines un­less the top num­ber was over 150.

Now, ev­ery­one that old should be treated if the top num­ber is over 130 un­less they’re too frail or have con­di­tions that make it un­wise.

“The ev­i­dence with this is so solid, so con­vinc­ing, that it’s hard to ar­gue with the tar­gets,” Jack­son Wright, a guide­lines panel mem­ber from Univer­sity Hos­pi­tals Cleve­land Med­i­cal Cen­ter, said.

Older peo­ple “have a 35 to 50fold higher risk of dy­ing of a heart at­tack or stroke com­pared to younger peo­ple”.

But the Cleve­land Clinic’s Steven Nis­sen said he was wor­ried.

“Some vul­ner­a­ble pa­tients who get treated very ag­gres­sively may have trou­ble with falls be­cause too-low pres­sure can make them faint,” he said.

Un­der new guide­lines, cer­tain groups, such as those with di­a­betes, should be treated if their top num­ber is over 130.

For the rest, whether to start med­i­ca­tion will no longer be based just on the blood pres­sure num­bers.

The de­ci­sion also should consider the over­all risk of hav­ing a heart prob­lem or stroke in the next 10 years, in­clud­ing fac­tors such as age, gen­der and choles­terol.

Those with­out a high risk will be ad­vised to im­prove their life­styles — lose weight, eat healthy, ex­er­cise more, limit al­co­hol, avoid smok­ing.

The guide­lines do warn about some pop­u­lar ap­proaches.

There is not enough proof that con­sum­ing gar­lic, dark choco­late, tea or cof­fee helps, or that yoga, med­i­ta­tion or other be­hav­iour ther­a­pies lower blood pres­sure long-term, they say.

Pic­ture: AP

Poor di­ets are a big cause of high blood pres­sure.

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