Local Physician Weighs in on New Blood Pressure Guidelines

The American Heart Association released new blood pressure guidelines this month that are sure to re-categorize many Hoosiers into the danger zone for hypertension. Jay Shah, M.D., a cardiologist and Medical Director of the Heart Valve Center for Porter Health Care System, said that while the new guidelines may seem scary for people who previously thought they were healthy, they represent an opportunity for Americans to recognize the signs of unhealthy blood pressure sooner.

“These new guidelines highlight the importance of early detection of hypertension and the appropriate treatment options that should be instituted. Recent landmark clinical trials have informed these new guidelines and will offer clinicians a comprehensive, up-to-date and focused resource on how best to address elevated blood pressure and hypertension when treating their patients,” he said. Shah is also a local expert speaker with the American Heart Association of Northwest Indiana.

In the first update to comprehensive U.S. guidelines on blood pressure detection and treatment since 2003, the category of prehypertension is eliminated. The new guidelines are:

• Normal: Less than 120/80 mm Hg
• Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80
• Stage 1: Systolic between 130-139 or diastolic between 80-89
• Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
• Hypertensive crisis: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

While about 14 percent more people will be diagnosed with high blood pressure and counseled about lifestyle changes, there will only be a small increase in those who will be prescribed medication.

“The release of the American Heart Association Guidelines on hypertension evaluation and treatment represents a significant resource for the clinical and public health practices in our Northwest Indiana communities,” Shah said. “Hypertension is responsible for significantly increasing the development of cardiovascular disease, heart attack, congestive heart failure, stroke, peripheral artery disease, kidney disease and abdominal aortic aneurysm.”

High blood pressure is known as the “silent killer” because often there are no symptoms.

Other changes in guidelines include:

• Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
• Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
• Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.

“These guidelines serve to empower our community to take charge of their health. They highlight how simple lifestyle changes focused on dietary modifications and exercise can make a profound impact on reducing blood pressure and the development of associated health effects,” Shah said.

Dietary changes and physical activity can be the first step in prevention and reduction of high blood pressure. The American Heart Association recommends adults get at least 150 minutes a week of moderate-intensity physical activity, such as brisk walking. They also recommend reading food labels, and avoiding foods that are high in sodium.

“Applying these guidelines will result in improved blood pressure management for our region, and most importantly, a dramatic improvement in cardiovascular health and quality of life,” Shah said.

Your health care provider should check your blood pressure at every visit. If you need a doctor, visit porterphysicians.com, which offers the opportunity to schedule your own appointment right from your mobile device or computer. You can also call 1-855-PPG-DOCS to find a physician near you.