it’s time to check your Blood pres­sure

New med­i­cal guide­lines lower the thresh­old

Khaleej Times - - FRONT PAGE - Asma Ali Zain

dubai — A slight change in screen­ing of the silent killer, high blood pres­sure, will im­prove the man­age­ment of the con­di­tion with long term ben­e­fits, said health ex­perts af­ter the Amer­i­can Heart As­so­ci­a­tion (AHA) low­ered the thresh­old for high blood pres­sure by say­ing it should be treated at a read­ing of 130/80 mm Hg in­stead of the pre­vi­ous limit of 140/90.

A lot younger pop­u­la­tion in their 40s in­stead of the ear­lier 50s could be at risk with the change in the read­ings. The new guide­lines say doc­tors now recog­nise that com­pli­ca­tions ‘can oc­cur at those lower num­bers’, in the first up­date to com­pre­hen­sive US guide­lines on blood pres­sure de­tec­tion and treat­ment since 2003.

Paul Whel­ton, lead au­thor of the guide­lines pub­lished in the AHA jour­nal, Hyper­ten­sion, and the Jour­nal of the Amer­i­can Col­lege of Car­di­ol­ogy, said, “It’s a yel­low light that you need to be low­er­ing your blood pres­sure, mainly with non-drug ap­proaches.”

As­so­ciate Prof Dr Walid Shaker, con­sul­tant car­dio­tho­racic sur­geon at Bur­jeel Hos­pi­tal in Abu Dhabi, said doc­tors would need to tell pa­tients to mod­ify their habits as early as they can as the dam­age to blood ves­sels can hap­pen at the read­ing of 130/80.

“The UAE is al­ways quick to adopt new guide­lines and hope­fully we will also do that soon,” he added. An ear­lier di­ag­no­sis of 130/80 had meant that pa­tients were nor­mal and could con­tinue to fol­low the life­style that they were fol­low­ing, he ex­plained.

He added that an early di­ag­no­sis does not mean that pa­tients would need to take med­i­ca­tion to con­trol the con­di­tion but should lose weight, ex­er­cise more, eat health­ier, avoid al­co­hol and salt, quit smok­ing and avoid stress. Ac­cord­ing to the new stan­dards, nearly half (46 per cent) of the US pop­u­la­tion will be de­fined as hav­ing high blood pres­sure.

Pre­vi­ously, one in three (32 per cent) had the con­di­tion, which is the sec­ond lead­ing cause of pre­ventable heart dis­ease and stroke, af­ter cig­a­rette smok­ing.

The nor­mal limit for blood pres­sure is considered 120 for sys­tolic, or how much pres­sure the blood places on the artery walls when the heart beats, and 80 for di­as­tolic, which is mea­sured be­tween beats.

Once a per­son reaches 130/80, “you’ve al­ready dou­bled your risk of car­dio­vas­cu­lar com­pli­ca­tions com­pared to those with a nor­mal level of blood pres­sure,” said Paul Whel­ton. “We want to be straight with peo­ple — if you al­ready have a dou­bling of risk, you need to know about it.”

Dam­age to the blood ves­sels is al­ready be­gin­ning once blood pres­sure reaches 130/80, said the guide­lines, which were based in part on a ma­jor US-gov­ern­ment funded study of more than 9,000 peo­ple na­tion­wide. “Peo­ple with those read­ings now will be cat­e­gorised as hav­ing ei­ther el­e­vated (120-129 and less than 80) or Stage I hyper­ten­sion (130-139 or 80-89).” Med­i­ca­tion is only rec­om­mended for peo­ple with Stage I hyper­ten­sion “if a pa­tient has al­ready had a car­dio­vas­cu­lar event such as a heart at­tack or stroke, or is at high risk of heart at­tack or stroke based on age, the pres­ence of di­a­betes mel­li­tus, chronic kid­ney dis­ease or cal­cu­la­tion of atheroscle­rotic risk.”

“I ab­so­lutely agree with the change in what is considered high blood pres­sure be­cause it al­lows for early life­style changes to be ad­dressed,” said Dr Satjit Bhusri, a car­di­ol­o­gist at Lenox Hill Hos­pi­tal in New York.

“It is im­por­tant, how­ever, to re­alise that the change in the def­i­ni­tion does not give course to in­crease pre­scrip­tion of med­i­ca­tions, rather that it brings to light the need to make life­style changes,” Bhusri said in an email to AFP.

Cer­tain groups, such as those with di­a­betes, should be treated if their top num­ber is over 130, the guide­lines say. 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, us­ing a sim­ple for­mula to es­ti­mate those odds.

Those with­out a high risk will be ad­vised to im­prove their life­styles — lose weight, eat healthy, ex­er­cise more, limit al­co­hol, avoid smok­ing. “It’s not just throw­ing meds at some­thing,” said one pri­mary care doc­tor who praised the new ap­proach, the Mayo Clinic’s Dr Robert Stroebel. If peo­ple con­tinue bad habits, “They can kind of eat and blow through the medicines,” he said.

The guide­lines warn about some pop­u­lar ap­proaches, though. There’s 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.

The new guide­lines were an­nounced at the Amer­i­can Heart As­so­ci­a­tion’s 2017 Sci­en­tific Ses­sions con­fer­ence in Ana­heim, Cal­i­for­nia.

as­maal­izain@khalee­j­times.com

(With in­puts from agen­cies)

AP

Jeff Ses­sions. —

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