High blood pressure is one of the most common conditions that patients present with in family medical practice. The older one gets the more likely he or she will develop high blood pressure. Blood pressure is measured in millimeters of mercury (mm Hg). In turn, that measurement consists of two numbers. First number or systolic blood pressure reading corresponds to the pressure in the arteries when the heart contracts. The second number or diastolic blood pressure reading corresponds to the pressure in the arteries when the heart relaxes.
Recently, new modified guidelines for high blood pressure classification and treatment have been released. According to new guidelines you may not need to be taking blood pressure medications. Here is a comparison of old and new recommendation by Joint National Committee. The new guidelines have been published in the Journal of American Medical Association on December 18, 2013.
Old guidelines: considered blood pressure readings of less than 120/80 mm Hg to be normal and anything up to 139/89 mm Hg as pre-hypertension. Blood pressure over 140/90mm Hg was labeled as stage 1 hypertension and that above or equal to 160/100 mm Hg as stage 2 hypertension. The old guidelines didn’t take age or presence of other chronic diseases into the algorithm for diagnosing and treating high blood pressure. Also, all diagnosed patients were initiated on the same medication, without regard to the race, once elevation of blood pressure was noted on three separate occasions.
New guidelines: Define hypertension by taking into account patient’s 1) age 2) presence of diabetes and presense of chronic kidney disease 3) race.
1) For adults 60 years of age or older, blood pressure of less than 150/90 mm Hg is considered normal. For adults younger than 60 years of age, blood pressure readings of less than 140/90 mm Hg is considered normal. No treatment with medication is recommended if blood pressure is within these ranges.
2) Adults under 60 years of age, with diabetes and either with or without chronic kidney disease, blood pressure less than 140/90 mm Hg is considered normal. Also, for adults under 60 years of age with chronic kidney disease and with or without diabetes, blood pressure readings less than 140/90 are considered normal.
3) Race is a factor when choosing a type of medication for treatment of high blood pressure in adults under 60 years of age.
Also, new guidelines focus on implementing lifestyle interventions such as weight loss, diet and exercise at all times of high blood pressure management regimen. New guidelines start patients on different combination of medications. Beta-blockers, for example, are not the first line medication and blacks get started on diuretics and calcium channel blockers rather than on ACE-inhibitors or angiotensin-converting enzyme blockers.
The threshold for normal blood pressure has been increased because there is not enough medical evidence to support that treating mild elevation in blood pressure can significantly reduce risks associated with high blood pressure such as stroke and heart attack. The side effects of blood pressure medications can outweigh the risk of going without them when blood pressure elevated mildly in people younger than 60.
Nevertheless, elevation in the blood pressure increases one’s risk of heart attack, stroke, developing chronic kidney disease, vision loss, as well as, premature death. Keep a record of blood pressure readings. There are a lot of blood pressure monitors available for home monitoring. At the physical share the results with the medical provider to determine the necessity of medication.