Q >> What is my blood pressure supposed to be? My doctor wants to add another medicine even though the readings I’m getting at home were within the range she advised at my last appointment. She seems to be telling me different things since last year.
A >> The guidelines for high blood pressure change. The newest guidelines were released in November 2017 by the ACC (American College of Cardiology) and the AHA (American Heart Association).
I felt the original 2014 version of the blood pressure guidelines by JNC 8 (8th Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of Hypertension) weren’t aggressive enough.
The acceptable blood pressure limits advocated by the JNC 8 in 2014 were higher than the previous version (JNC 7). At that time, the Sprint Study had recently been discontinued three years early because it showed that there was a significantly lower incidence of strokes, heart attacks, heart failure, cardiovascular deaths, and all cause mortality in the aggressive treatment group (whose systolic blood pressure averaged 121.4 mm Hg) vs the group averaging 136.2 mm Hg. The final guidelines (including JNC 8) are stricter and advocate treating blood pressure at 130/80 instead of 140/90.
The most recent, final blood pressure guidelines by the ACC and AHA are as follows:
• Normal is • Elevated is 120-129 mm Hg/• High (Stage 1) is 130-139 mm Hg systolic (higher number) or 80-89 mm Hg diastolic (lower number)
• High (Stage 2) is 140 mm Hg or greater or 90 mm Hg or greater diastolic blood pressure
• Hypertensive crisis: systolic over 180 and/or diastolic over 120 mm Hg.
Discuss this with your doctor. Refer to the ACC’s High Blood Pressure Guidelines Hub at http://www.acc.org/guidelines/ hubs/high-blood-pressure for recommended blood pressure guidelines, treatment recommendations, and lifestyle modifications including calculating BMI, smoking cessation tips, the DASH diet, weight loss and exercise advice. Lifestyle modifications are in order to improve blood pressure and reduce risks of cardiovascular events. Lifestyle modifications include limiting salt intake, eating a healthy diet, regular exercise, maintaining a healthy level of cholesterol and a BMI of 25 or less, relaxation and stress reduction. Quit smoking and limit your alcohol intake (to one drink per day for women, two for men).
For some people with mild hypertension who don’t have diabetes, kidney disease, or any other cardiovascular risk factors, lifestyle modifications alone may be enough to lower blood pressure into the normal range. For others, one or more medications may be necessary to control blood pressure in addition to lifestyle modifications. Better yet, start living a healthy lifestyle now to lower your risk of having hypertension later in life. The new guidelines will result in nearly one half of the U.S. adult population having high blood pressure! Even for people with normal blood pressure at age 55, you still have a 90% chance of developing hypertension. High blood pressure doubles your risk for cardiovascular events, even more so if you have other cardiovascular risk factors. Hypertension can lead to serious conditions like strokes, heart attacks, kidney failure, and eye disease.
Your blood pressure varies throughout the day and night. Check it using proper technique and a validated device. Your recommended blood pressure range varies depending on your age, other medications you are taking, your other medical conditions, and on how you tolerate treatment.
Ask your doctor what range of blood pressure is acceptable for you. If your blood pressure is too low, it can cause fainting, kidney problems and electrolyte imbalances. Be sure to discuss it with your doctor before discontinuing any medication.
Dr. Marian Wymore, MD is a geriatric medicine specialist on the Palos Verdes Peninsula.