High blood pressure -- Controlling blood pressure can decrease risk of heart attacks and stroke
Douglas J. Lanska, M.D. Chief of Staff Tomah VA Medical Center, Tomah, WI
High blood pressure, or hypertension, affects approximately 50 million people in the United States and leads to heart attacks, heart failure, strokes, kidney disease, and other serious complications. With proper medical treatment, though, the risks of high blood pressure can be markedly reduced.
New guidelines from the Joint National Committee for high blood pressure management and prevention were recently published.
Blood pressure is reported as two numbers. The top number is the systolic blood pressure, the pressure in the arteries when the heart beats. The bottom number is the diastolic blood pressure, the pressure in the arteries when the heart is refilling with blood for the next heart beat.
In the new classification of blood pressure, people with a blood pressure less than 120/80 are considered "nonnal". That means that the systolic blood pressure is less than 120 and the diastolic blood pressure is less than 80.
People with a blood pressure between 120/80 and 139/89 have "prehypertension" and are at increased risk for progression to high blood pressure. People with prehypertension should change their lifestyle to decrease the risk of heart disease.
People with blood pressure over 140/90 have high blood pressure or hypertension need to make changes in their lifestyle and should also be treated with medications.
The goal of treatment is to decrease the blood pressure to at least 140/90 in most patients, and to at least 130/80 in patients with diabetes or kidney disease. Treating high blood pressure to lower targets can further decrease the risk of medical complications.
In people older than 50 years, the top blood pressure number (the systolic blood pressure) is the most important number for predicting heart disease risk.
Certain lifestyle changes can decrease blood pressure, improve the effectiveness of high blood pressure medications, and by themselves can directly decrease the risk of heart disease:
. Maintain a nonnal body weight
. Eat a diet that is rich in fruits, vegetables, and low-fat dairy products, and low in saturated fat and total fat.
. Decrease salt intake to no more than 6 gm of salt (ie - 2.4 grams of sodium) a day
. Participate in regular aerobic physical activity for at least 30 minutes most days of the week. Examples include brisk walking, bicycling, and jogging.
. Limit alcohol to no more than 2 drinks a day for most men, and 1 drink a day for women and lighter-weight men.
A specific type of "water pill" called a thiazide diuretic should be used for drug treatment of most patients with high blood pressure. Low-dose water pills are the most effective fIrst-line treatment for preventing heart disease in patients with high blood pressure. For most patients they are better than newer and more expensive medications.
Most patients with high blood pressure and especially those with a blood pressure over 160/100 will need at least two medications to control their blood pressure.
Without lifestyle changes, medications may not be effective in controlling blood pressure. Patients need to be motivated to make the changes that are necessary to control their blood pressure and decrease their risk of heart attacks, heart failure, strokes, and kidney disease.
Most patients should see their medical provider for follow-up and medication adjustment about every month until the blood pressure goal is reached. Patients with very high blood pressure over 160/100 or with complicating medical problems will need more ftequent office visits.
