Hypertension is one of the leading non-communicable diseases (NCDs) besides diabetes and obesity. Numerous efforts have been made to reduce the complications of high blood pressure. The latest being a reclassification in the readings, recommended by the American Heart Association (AHA). High blood pressure is now defined as readings of 130mmHg and higher for the systolic blood pressure (SBP) measurement, or readings of 80 and higher for the diastolic (DBP) measurement.

With this new change, people are questioning the rationale behind, as it was already difficult to maintain even the previous target – which is 140. Is lowering the values more beneficial?

“The latest medical evidence has proven that people with blood pressure in the 130 – 139 range carry a doubled risk of heart attack, stroke, heart failure and kidney failure, compared to those with lower blood pressure,” explained Dr Joaquin Cigarroa, a member of the clinical guidelines task force.

The guideline also states that damage to the blood vessels is already beginning once blood pressure reaches 130/80, further strengthening the argument.

With the new update, ‘pre-hypertension’ has been omitted and people with those blood pressure readings are categorised as having either Elevated or clear-cut Stage 1 Hypertension.

Prehypertension has been omitted in the new guideline. Source: LiveScience/AHA
Prehypertension has been omitted in the new guideline. Source: LiveScience/AHA

Dr Paul Whelton, lead author of the guidelines wants the public to be aware “if they already have an increased risk to develop complications from elevated blood pressure.”

"It doesn't mean you need medication; but, it's a yellow light that you need to be lowering your blood pressure," noted Whelton in a statement.

Only one in five of people diagnosed with Stage 1 Hypertension will need medication, while the rest only need lifestyle modifications and follow up every three to six months.

Lifestyle modification and medication

The guideline states that with this new level of diagnosis, it does not mean that patients need to start medication straight away, although they are already considered hypertensives. The first step will still be lifestyle modification, especially in those without risk factors.

The diagnosis of hypertension must be done with proper technique "based on an average of two to three readings on at least two different occasions” according to the guideline. At least two home readings of 130/80 should be done, while the level at the clinic remains 140/90 as stress and ‘white-coat’ hypertension are still taken into consideration.

Drug interventions are only for those with risk factors such as previous heart attack, diabetes, high cholesterol, obstructive sleep apnoea and renal failure.

"It is important, however, to realise that the change in the definition does not give course to increase prescription of medications, rather that it brings to light the need to make lifestyle changes," highlighted Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York.

The World Health Organisation (WHO) has also provided a list of proven lifestyle modifications that reduce blood pressure such as reducing alcohol intake and cessation of smoking.

Including exercise in a person’s lifestyle has tremendous positive effects such as weight loss, strengthening the heart and body muscles and improve one’s stamina.

Diet with fresh fruits and vegetables that are rich in potassium, such as bananas, potatoes, avocados and dark leafy vegetables are also beneficial coupled with reducing salt intake.

High-risk groups

Home monitoring should be made mandatory so that patients always know their base line reading.

This is however, easier said than done as the minorities in America do not have the luxury of home blood pressure monitoring or even frequent visits to physicians just to check their blood pressure level. High blood pressure affects minority groups even as early as in their 20s and is most often undiagnosed.

"We know that African American and Mexican Americans in particular have some of the highest rates of high blood pressure and we know that this increases the risk of heart attack, stroke, kidney disease and the like," said Dr Aaron Horne, a cardiologist at Methodist Dallas.

He further stated that “within African American communities and Latino communities, there's less penetrance of those individuals having primary care physicians.”
Pregnant women will also benefit from this new level as earlier intervention can be done. The risks are increased as hormonal and bodily changes causes more pressure to the vessels – thus, increasing the likelihood of having increased blood pressure.

Any form of hypertension in pregnancy such as gestational hypertension, chronic hypertension and preeclampsia can lead to heart failure which further complicates the delivery, endangering both mother and baby.

Patient education is vital as complications such as stroke, heart attack and renal failure are highly significant in patients with hypertension. With this new level, people should be on their toes and understand the need to make lifestyle changes at an early stage. MIMS

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