Half of US adults have high blood pres­sure in new health guide­lines

Manteca Bulletin - - Local/State -

ANA­HEIM (AP) — New guide­lines lower the thresh­old for high blood pres­sure, adding 30 mil­lion Amer­i­cans to those who have the con­di­tion, which now plagues nearly half of U.S. adults.

High pres­sure, which for decades has been a top read­ing of at least 140 or a bot­tom one of 90, drops to 130 over 80 in ad­vice an­nounced Mon­day by a dozen med­i­cal groups.

The change means an ad­di­tional 14 per­cent of U.S. adults have the prob­lem, but only an ad­di­tional 2 per­cent will need med­i­ca­tion right away; the rest should try health­ier life­styles, which get much stronger em­pha­sis in the new ad­vice. Poor di­ets, lack of ex­er­cise and other bad habits cause 90 per­cent 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,’” said Dr. Paul Whel­ton, a Tu­lane Univer­sity physi­cian who led the guide­lines panel.

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, but a ma­jor study two years ago found heart risks were much lower in peo­ple who aimed for 120. Canada and Aus­tralia low­ered their cut­off to that; Europe is still at 140 but is due to re­vise its guid­ance next year.

The guide­lines were an­nounced Mon­day at an Amer­i­can Heart As­so­ci­a­tion con­fer­ence in Ana­heim.

WHAT THE CHANGES MEAN The guide­lines set new cat­e­gories and get rid of “pre­hy­per­ten­sion”: ▶Nor­mal: Un­der 120 over 80 ▶El­e­vated: Top num­ber 120-129 and bot­tom less than 80

▶Stage 1: Top of 130-139 or bot­tom of 80-89

▶Stage 2: Top at least 140 or bot­tom at least 90

That means 46 per­cent of U.S. adults have high pres­sure (stages 1 or 2) ver­sus 32 per­cent un­der the old lev­els.

How com­mon it is will roughly triple in men un­der 45, to 30 per­cent, and dou­ble in women of that age, to 19 per­cent.

For peo­ple 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,” said Dr. Jack­son Wright, a guide­lines panel mem­ber from Univer­sity Hos­pi­tals Cleve­land Med­i­cal Cen­ter. Older peo­ple “have a 35-to50-fold higher risk of dy­ing of a heart at­tack or stroke com­pared to younger peo­ple.”

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

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

WHO NEEDS TREAT­MENT 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.

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