What’s your BP?

A new stan­dard for high blood pres­sure means many more have it.

The Washington Post - - FRONT PAGE - BY LENNY BERN­STEIN AND ARIANA EUNJUNG CHA leonard.bern­stein@wash­post.com ariana.cha@wash­post.com

Lead­ing heart health ex­perts tight­ened the guide­lines for high blood pres­sure Mon­day, a change that will sharply in­crease the num­ber of U.S. adults con­sid­ered hy­per­ten­sive in the hope that they, and their doc­tors, will ad­dress the deadly con­di­tion sooner.

The Amer­i­can Heart As­so­ci­a­tion, the Amer­i­can Col­lege of Car­di­ol­ogy and nine other groups re­de­fined high blood pres­sure as a read­ing of 130 over 80, down from 140 over 90. The change, the first in 14 years, means that 46 per­cent of U.S. adults, many of them younger than 45, now will be con­sid­ered hy­per­ten­sive. Un­der the pre­vi­ous guide­line, 32 per­cent of U.S. adults had high blood pres­sure.

“We’re rec­og­niz­ing that blood pres­sures that we in the past thought were nor­mal or so-called pre-hy­per­ten­sive ac­tu­ally placed the pa­tient at sig­nif­i­cant risk for heart dis­ease and death and dis­abil­ity,” said Robert M. Carey, co-chair­man of the group that pro­duced the new re­port. “The risk hasn’t changed. What’s changed is our recog­ni­tion of the risk.”

But the re­port’s au­thors pre­dicted that rel­a­tively few of those who fall into the new hy­per­ten­sive cat­e­gory will need med­i­ca­tion. Rather, they hope that many found with the early stages of the con­di­tion will be able to ad­dress it through lifestyle changes such as los­ing weight, im­prov­ing their diet, get­ting more ex­er­cise, con­sum­ing less al­co­hol and sodium, and low­er­ing stress.

The guide­lines should be in­flu­en­tial in clin­i­cal prac­tice, with most health-care providers ex­pected to fol­low the rec­om­men­da­tions. In ad­di­tion to tight­en­ing the def­i­ni­tion of high blood pres­sure, the new re­port does away with the old cat­e­gory of “pre­hy­per­ten­sion,” which was de­fined as a top (sys­tolic) read­ing of 120 to 139 or a bot­tom (di­as­tolic) num­ber be­tween 80 and 89.

The new guide­lines cre­ate cat­e­gories in­clud­ing “el­e­vated,” “Stage 1 and 2 hy­per­ten­sion,” and “hy­per­ten­sive cri­sis,” each char­ac­ter­ized by var­i­ous blood pres­sure read­ings. A read­ing of 120 over 80 will still be con­sid­ered nor­mal.

The sys­tolic read­ing refers to the pres­sure when the heart con­tracts and sends blood through the ar­ter­ies. Di­as­tolic pres­sure is mea­sured when the heart re­laxes be­tween beats.

The guide­lines sug­gest that doc­tors rec­om­mend lifestyle changes for peo­ple found to have el­e­vated blood pres­sure. Those with Stage 1 hy­per­ten­sion should be as­sessed for their 10-year risk of heart dis­ease or stroke un­der the pa­ram­e­ters of a widely used ma­trix for car­dio­vas­cu­lar health. Those with more than a 10 per­cent chance, or other com­pli­cat­ing fac­tors, should try med­i­ca­tion.

“An im­por­tant cor­ner­stone of these new guide­lines is a strong em­pha­sis on lifestyle changes as the first line of ther­apy. There is an op­por­tu­nity to re­duce risk with­out nec­es­sar­ily im­pos­ing med­i­ca­tions,” said Richard Chazal, the im­me­di­ate past pres­i­dent of the Amer­i­can Col­lege of Car­di­ol­ogy.

The au­thors of the re­port ex­pect that many adults younger than 45 will find them­selves in­cluded un­der the new thresh­old. The lower score is ex­pected to triple the num­ber of younger men and dou­ble the num­ber of younger women con­sid­ered hy­per­ten­sive.

High blood pres­sure is the lead­ing cause of death world­wide and the sec­ond-lead­ing cause of pre­ventable death in the United States, af­ter cig­a­rette smok­ing. Hy­per­ten­sion leads to car­dio­vas­cu­lar dis­ease, stroke, se­vere kid­ney dis­ease and other mal­adies that kill mil­lions ev­ery year. Blood pres­sure is af­fected by a wide va­ri­ety of fac­tors in­clud­ing ge­net­ics, age, diet, ex­er­cise, stress and other dis­eases, such as di­a­betes. Men are more likely to have high blood pres­sure than women, and blacks are more likely to have it than whites. Many peo­ple are un­aware that they have the con­di­tion be­cause there are no symp­toms.

Much of the data to sup­port the up­date came from the Sys­tolic Blood Pres­sure In­ter­ven­tion Trial, or SPRINT, a large-scale study of more than 9,000 peo­ple spon­sored by the National Heart, Lung and Blood In­sti­tute. When the re­sults were first pre­sented in 2015, they shook many as­sump­tions about blood pres­sure man­age­ment.

The study showed that bring­ing blood pres­sure be­low 120 rather than the rec­om­mended 140 to 150 could re­duce the risk of heart at­tack and stroke. While that re­search only in­cluded peo­ple 50 and older and at high risk for heart prob­lems, sub­se­quent stud­ies have shown this ben­e­fit ap­pears to ex­tend to younger peo­ple as well, said Chazal, who is med­i­cal di­rec­tor at Lee Health in Fort My­ers, Fla.

Thomas R. Frieden, the for­mer di­rec­tor of the U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion who now runs a global health ini­tia­tive that fo­cuses on heart dis­ease and stroke, called hy­per­ten­sion “the world’s most un­der­ad­dressed pre­ventable health prob­lem.” Frieden said that one of the rea­sons treat­ment has been slow to catch on is what he called “ther­a­peu­tic in­er­tia,” the re­luc­tance of some physi­cians and pa­tients to try med­i­ca­tion when a per­son with high blood pres­sure ap­pears to be other­wise healthy.

“It is not easy to take drugs for the rest of your life for a con­di­tion you are not sick from,” he said. “There is a rea­son it’s known as the silent killer.”

“The risk hasn’t changed. What’s changed is our recog­ni­tion of the risk.” Robert M. Carey, co-chair­man of the group that pro­duced the new re­port

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