Re­main calm


West Hawaii Today - - Front Page - BY JEFF HANSEL

HILO — Hawaii Is­land health pro­fes­sion­als want com­mu­nity mem­bers to re­main calm — even though new guide­lines say about 46 per­cent of U.S. adults are now con­sid­ered to have high blood pres­sure.

The new guide­lines were an­nounced Mon­day. High blood pres­sure, or hy­per­ten­sion, used to be de­fined as 140/90. Ac­cord­ing to the Amer­i­can Col­lege of Car­di­ol­ogy, blood pres­sure guide­lines are:

• Nor­mal: Less than 120/less than 80 • El­e­vated: 120-129/less than 80 • Hy­per­ten­sion Stage 1: 130-139/80-89

• Hy­per­ten­sion Stage 2: Greater than or equal to 140/greater than or equal to 90

The change comes from a 2017 up­date of a 2003 re­port called the “Sev­enth Re­port of the Joint Na­tional Com­mit­tee on Pre­ven­tion, De­tec­tion, Eval­u­a­tion and Treat­ment of High Blood Pres­sure.”

The re­port’s guid­ance has been adopted by or­ga­ni­za­tions such as the ACC, the Amer­i­can Col­lege of Pre­ven­tive Medicine, the Amer­i­can Heart As­so­ci­a­tion and sev­eral oth­ers. Physi­cians and other health prac­ti­tion­ers fol­low the re­search-based rec­om­men­da­tions of such groups when con­sid­er­ing which treat­ments to of­fer pa­tients. On Hawaii Is­land, many pa­tients have mul­ti­ple co-oc­cur­ring chronic health con­di­tions, such as di­a­betes, obe­sity and high blood pres­sure, said Bay Clinic Med­i­cal Di­rec­tor Dr. Chrissy Ca­p­ati. Such in­di­vid­u­als are at higher risk of de­vel­op­ing heart dis­ease than the gen­eral pop­u­la­tion.

“Peo­ple have been sort of falsely re­as­sured,” said Hilo Med­i­cal Cen­ter Car­di­ol­o­gist Dr. David Grif­fin.

If we wait un­til we’re 140/90, we’re sort of miss­ing the boat. DR. DAVID GRIF­FIN CAR­DI­OL­O­GIST HILO MED­I­CAL CEN­TER

He said the new guide­lines, how­ever, can help peo­ple coun­ter­act high blood pres­sure by start­ing to con­trol it early, thereby pre­vent­ing or de­lay­ing de­vel­op­ment of heart dis­ease.

“If we wait un­til we’re 140/90,” Grif­fin said, “we’re sort of miss­ing the boat.”

He ad­vises work­ing against high blood pres­sure early, to pre­vent it from get­ting out of con­trol.

Ca­p­ati, a board-cer­ti­fied fam­ily physi­cian, said pa­tients can make sig­nif­i­cant dif­fer­ence in blood pres­sure by ceas­ing to smoke to­bacco prod­ucts and ex­er­cis­ing.

“Smok­ing is one of the big­gest risk fac­tors peo­ple have for de­vel­op­ing high blood pres­sure, and all the things that come along with that,” she said.

Grif­fin also sug­gests stress re­lief as an im­por­tant treat­ment op­tion, eat­ing a healthy diet and con­sid­er­ing life­style changes “first and fore­most” as treat­ment op­tions. Los­ing 10 pounds dur­ing the course of a year will sig­nif­i­cantly af­fect blood pres­sure, he said, as will walk­ing 30 min­utes a day for six days a week.

Salt in­take is an­other fac­tor in high blood pres­sure, but not ev­ery­body needs to de­crease how much salt they eat, Grif­fin said, em­pha­siz­ing “it re­ally starts with a con­ver­sa­tion with your fam­ily doc­tor.”

Rec­om­men­da­tions for a heart-healthy diet in­clude re­duc­ing salt and in­cor­po­rat­ing potas­sium-rich foods such as ba­nanas, pota­toes, av­o­ca­dos and dark leafy veg­eta­bles. Los­ing weight, quit­ting cig­a­rettes, cut­ting back on al­co­hol and in­creas­ing phys­i­cal ac­tiv­ity also help heart health.

A physi­cian will de­ter­mine a per­son’s risk fac­tors and treat­ment op­tions, Grif­fin said. Most peo­ple con­sid­ered newly hy­per­ten­sive will not need medicine.

He and Ca­p­ati said there are mul­ti­ple anti-hy­per­ten­sive drugs avail­able for those who do need them, in­clud­ing low-cost, generic di­uret­ics, beta block­ers and cal­cium chan­nel block­ers. Grif­fin said side ef­fects of medicines can be com­pen­sated for, such as the mus­cle aches and cramps that can oc­cur with di­uret­ics. Peo­ple at greater risk, such as those with di­a­betes, a prior stroke or prior heart at­tack, should con­sider more ag­gres­sive treat­ment, in con­sul­ta­tion with their health provider.

“Work with your physi­cian to make sure that you mit­i­gate side ef­fects,” Grif­fin said. “It’s a part­ner­ship with your doc­tor.”

The new blood pres­sure guide­lines — in the works for about three years and based on hun­dreds of stud­ies and clin­i­cal tri­als — don’t sug­gest a mas­sive in­crease in the num­ber of peo­ple who will need to take med­i­ca­tion to con­trol hy­per­ten­sion.

Of the es­ti­mated 14 per­cent more adults to be clas­si­fied with high blood pres­sure, about one in five will need med­i­ca­tion, ac­cord­ing to Dr. Paul Whel­ton, who chaired the guide­line writ­ing com­mit­tee. But tak­ing into ac­count the over­all pop­u­la­tion of adults who now will have hy­per­ten­sion, the guide pre­dicts only a small per­cent­age more should be pre­scribed medicine for it, com­pared with the pre­vi­ous rec­om­men­da­tions re­leased in 2003.

The new guide­lines, pub­lished in the AHA’s journal Hy­per­ten­sion, em­pha­size that doc­tors need to fo­cus on a whole frame­work of health­ier life­style changes for pa­tients.

“We need to send the mes­sage that yes, you are at in­creased risk and th­ese are the things you should be do­ing,” said Whel­ton, chair­man of global pub­lic health at Tu­lane Univer­sity in New Or­leans. “I’m not say­ing it’s easy to change our life­styles, but that should be first and fore­most.”

Ca­p­ati said blood pres­sure also isn’t a one-time check. Rather, physi­cians watch for a pat­tern of high read­ings.

And is it your blood pres­sure — or the doc­tor?

“White coat syn­drome” hap­pens when pa­tients get stressed into high blood pres­sure when at the doc­tor’s of­fice.

Ca­p­ati said if a pa­tient keeps a home blood-pres­sure log it can help the physi­cian know if white coat syn­drome is a fac­tor.

“It’s a real thing,” she said. “It re­ally does hap­pen.”

Of­ten called the “si­lent killer” be­cause there can be no ob­vi­ous symp­toms, hy­per­ten­sion ac­counts for more heart dis­ease and stroke deaths than al­most all other pre­ventable causes. It’s sec­ond only to smok­ing.

Amer­i­can Heart As­so­ci­a­tion News con­trib­uted to this ar­ti­cle.


A blood pres­sure cuff is shown here. Even though new guide­lines say about 46 per­cent of U.S. adults are now con­sid­ered to have high blood pres­sure, Hawaii Is­land health pro­fes­sion­als say com­mu­nity mem­bers should re­main calm.

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