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New guidelines decrease risk for hypertension.

High blood pressure (hypertension) is known as the silent killer because it typically has no symptoms until after it has done significant damage. Hypertension, if left untreated, may lead to cardiovascular events, kidney damage and strokes. The good news is that after much research on how to better prevent complications, the American Heart Association and American College of Cardiology have revised the definition of hypertension and issued new guidelines for treatment. These new guidelines will have a significant impact on public health in the United States as they will help doctors identify, classify and treat high blood pressure.

Understanding the New Guidelines
Blood pressure is the force of your blood pushing against the walls of your arteries each time your heart beats. The first number in a blood pressure reading (the systolic pressure) represents the force exerted when your heart contracts. The second number (the diastolic pressure) measures the force exerted between beats. “Research has confirmed that elevated systolic blood pressure has been a better predictor of cardiovascular disease risk than diastolic blood pressure,” says Touro’s Dr. Bashar Ababneh. “Previously, systolic pressures from 120 to 139 millimeters of mercury or diastolic pressures from 80 to 89 millimeters of mercury were considered prehypertension, and it served as a notice that those patients were at risk for high blood pressure in the future. If the systolic pressure readings were greater than 140 millimeters of mercury or the diastolic pressure readings were greater than 90 millimeters of mercury, then the patient was diagnosed as having hypertension.”

But as Dr. Ababneh, who is board-certified in internal medicine, cardiovascular disease, and interventional cardiology, explains, the term prehypertension may be a thing of the past. “Prior to the new guidelines, if there was a systolic blood pressure of 140 or greater and/or a diastolic blood pressure of 90 or more, that was considered high blood pressure and readings less that that were considered prehypertension,” he says. “Now, a systolic blood pressure of 120 over 80 is ‘elevated’ and patients with readings of more than 130 over 80 will be classified as having stage 1 high blood pressure. With these new guidelines, we will have a better opportunity to work on preventing the life-threatening complications of hypertension.”

How do These Guidelines Impact Treatment?
For those who are defined as having elevated blood pressure, lifestyle modification such as diet, exercise, weight loss and salt restriction is recommended. “It is vital that those with high blood pressure work diligently to maintain a healthy body weight through diet and exercise,” Dr. Ababneh says. “At Touro, we recommend that our patients use the American Heart Association’s DASH diet, which lowers blood pressure and reduces people’s risk of stroke and heart failure. In addition, drinking fewer than two drinks per day for men and one drink per day for women also lowers heart risk.”

For patients who are classified as stage 1 high blood pressure, the guidelines suggest that treatment will depends solely on risk. If a person has diabetes, kidney disease or a high estimated 10-year cardiovascular risk using the ACC/AHA Pooled Cohort Equations, medical therapy with blood pressure medications should be initiated immediately in addition to lifestyle modification. For those with a prior cardiac event such as a heart attack or stroke, medical therapy with blood pressure medications should also be initiated at the time of diagnosis. “For an average risk person with stage 1 hypertension, the guidelines recommend a trial period of lifestyle modification with monitoring and close follow-up with a physician,” Dr. Ababneh says. “If lifestyle modification does not produce results and adequate blood pressure control, then we may prescribe medications.”

There are many drugs used to treat high blood pressure, including diuretics, beta-blockers and ACE inhibitors, which attack blood pressure from different directions. “Medication may be prescribed to those patients who have a history of cardiovascular disease or strokes, or if their future risk is greater than 10 percent in the next 10 years,” Dr. Ababneh explains. “And for those with stage 2 high blood pressure, treatment will include drug therapy at the time of diagnosis as well as recommended lifestyle changes.”

The new definition for high blood pressure highlights the importance of preventing high blood pressure in the first place, and, according to Dr. Ababneh, lifestyle modification should always be a part of any comprehensive therapy for hypertension. “People with blood pressure levels between 130 and 140 are at about twice the risk of heart attack and stroke as people with normal levels,” he says. “At Touro, we use a collaborative approach to treating hypertension, and our team of doctors, nurses and dietitians does its best to help patients take the proper steps to a healthier heart.”

Signs of Hypertension
High blood pressure is a common disease, and it can damage your body and its organs over a long period of time. However, you may not have symptoms. If you do have symptoms, they may include headache, dizziness and fatigue — just to name a few. The best way to determine if you have high blood pressure is to see your primary care physician on a regular basis. Each doctor’s visit usually begins with a nurse checking your vital signs: pulse (heart rate) and blood pressure.

Allowing your physician to see how your blood pressure readings change over time and how the readings vary at different times of the day can help them better prescribe medications and develop your most effective comprehensive treatment plan. High blood pressure is very treatable.

“If you find out that you have high blood pressure or if you suspect you may have high blood pressure, it’s vital that you measure your blood pressure at home daily,” Dr. Ababneh says. “We recommend that you keep a blood pressure log and bring that log with you to your office visits. In addition, bring your home blood pressure cuff with you to your next office visit so we can make sure your device is calibrated correctly. We want to be sure you are getting accurate readings at home.”