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Detection and treatment of high blood pressure

Created date

February 20th, 2018
man having high blood pressure reading done by medical professional

Recently, new guidelines for the detection, evaluation, and management of high blood pressure in adults were released by a number of medical associations in the Journal of the American Medical Association. There has been much discussion and comment on these recommendations, and what may have seemed like a relatively straightforward area of medicine—high blood pressure—is in fact more complex than ever. While our knowledge on the subject continues to grow, what you should do individually requires careful consideration of your unique circumstances in discussion with your physician. 

Blood pressure (BP) itself may seem like a vague concept, and we all know high blood pressure (HBP) is not good, but why is that the case? BP is the force of your blood against your artery walls. Systolic blood pressure (SBP—the top number in a blood pressure reading) is how much pressure is exerted when your heart beats, and diastolic blood pressure (DBP) is how much force is exerted when your heart rests between beats. In general, the more your blood pressure is above normal levels, the greater your risk of cardiovascular and kidney disease as well as stroke.

What is the ‘normal’ range?

The fundamental question that has been studied intensively and extensively for decades is what is the normal BP range and how does it vary by age and by the presence of conditions such as diabetes and kidney disease? One of the most challenging aspects of all areas of medicine is defining “normal” because there is so much variation among us. This is certainly the case for BP, where even the way it is measured impacts ideal ranges. Measurements taken at home and after 10 minutes of rest will be lower than measurements taken after being rushed into an exam room. 

The impact of nonmedication options

One thing that all physicians agree upon is that nonmedication options have been shown to be quite successful at lowering blood pressure. Collectively, lifestyle modifications have been shown to decrease SBP an average of 5 – 10 mm Hg. Your doctor may recommend that you lose weight, increase your physical activity, and change what you eat. The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to decrease SBP an average of 11 mm Hg. The DASH diet emphasizes vegetables, fruits, whole grains, low-fat dairy products, and lean meats. It also emphasizes consuming a daily maximum of 2,300 milligrams (mg) of salt for most people, and a maximum of 1,500 mg for people with cardiovascular disease (these amounts include salt in food you eat, as well as what’s in the salt shaker if you use it). The DASH recommendations also include moderating your alcohol consumption. 

Whether to use medication can be a complicated decision, particularly for older patients. The risks and benefits need to be carefully considered. Risks include adverse effects, interactions with other medications, and cost. Now more than ever, clinicians and patients should discuss BP and their individual situation in order to arrive at a shared decision on the best treatment approach to maintain well-being.

Dr. Narrett leads the medical team at all Erickson Living communities. A graduate of Harvard Medical School, he has been providing care for seniors for over three decades.