Area doctors reflect on new hypertension guidelines, which lowered the cutoff reading

COURTESY: KAISER PERMANENTE - Dr. Tim Jacobson, Chief of Cardiology, at Kaiser Permanente getting blood pressure readings from a patient.It has been about a month since newspapers, and broadcast media throughout the country, trumpeted the dramatic news that blood pressure guidelines have been updated.

High blood pressure now begins with a lower reading of 130/80, which means many more patients will be diagnosed with a potentially dangerous condition that usually has no symptoms.

Chief of Cardiology at Kaiser Permanente, Dr. Tim Jacobson, is optimistic about the latest news.

"It's actually helpful. Over time, as one of my colleagues told me this morning, we've had kind of a yo-yoing in terms of where our targets for blood pressure management have been," Jacobson said. "It had been lower, then it was higher, now it's lower again."

Jacobson continued, "It (new guidelines) helps us frame conversations with patients and helps give context to why we're asking them to get their blood pressure lower — the national media focus on this topic is actually quite helpful for us when we have to see patients at the clinic, because they're primed for a discussion about this topic and they may have already read a little bit about the importance of controlling their blood pressure."

GLUCKMANDr. Ty Gluckman, a cardiologist with Providence Heart Institute, also views the new guidelines as positive. Noting that cardiovascular disease continues to be the number one killer of men and women alike, Gluckman said, "High blood pressure is one of many risk factors but it's the most prevalent risk factor that contributes to cardiovascular risk."

Gluckman added, "It (new guidelines) means that we will be doing more to reduce the risk for those patients — this will be a challenge for care providers, and patients alike, to achieve these goals, but it's a challenge I warmly welcome because I think the net benefit — is going to be a net reduction in the rate of adverse cardiovascular events, like heart attack and stroke."

Almost one out of every two Americans will have high blood pressure under these guidelines, Gluckman said, adding the guidelines will "bring greater attention to the condition and will hopefully, fingers crossed, put more attention on a lot of the things we can do, above and beyond medication, to help influence our blood pressure."

Untreated high blood pressure, Gluckman said, can lead to heart attack, death from cardiovascular disease, stroke and kidney problems (including kidney failure).

There are a number of things we can do to lower our blood pressure, including restricting salt, increasing potassium in our diet, losing weight through diet and exercise, avoiding or minimizing alcohol and restricting caffeine intake.

"And the good news is, if one or more of those things are done, it has beneficial effects," Gluckman said. "The new guidelines do a really good job of reinforcing that any medications that are initiated are done so to complement, not replace, lifestyle interventions (healthful behaviors)."

Gluckman said doctors may have differences of opinion about these guidelines as they apply to select patient populations, but, "I think most clinicians can get behind this."

Jacobson pointed out, "As we (doctors) look to apply these guidelines, it's important to remember that we can't universally apply them to everybody without individualizing some of the decision making. I think a lot of what physicians will react to is they will still want to have the ability to individualize some of these recommendations."

While the skeptics among us may think these new guidelines are a huge gift for the pharmaceutical industry, Jacobson has a different take.

"The good news for us, in terms of treating blood pressure, is that the vast majority of the medications (most of them generic, inexpensive options) we would use have been around for decades," Jacobson said. "It's very uncommon that we're really going to enrich any drug maker by using a given blood pressure medication."

Managing blood pressure can be like having an insurance policy, according to Jacobson. The new guidelines are "about trying to improve an individual's health and provide us, really, what I see as an insurance policy against devastating health consequences that we, really, all like to avoid."

More about high blood pressure

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Risk factors

  • Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in blacks.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • Too little vitamin D in your diet. It's uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea. Sometimes pregnancy contributes to high blood pressure, as well.
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    Scott Keith is a freelance writer for the Portland Tribune and the Pamplin Media Group. If you have a health tip, or a story idea, contact Scott at: This email address is being protected from spambots. You need JavaScript enabled to view it.

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