New high blood pressure guideline focuses on prevention and early treatment

Preventing and managing high blood pressure is crucial for maintaining good health. The new Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults from the American Heart Association and the American College of Cardiology offers new guidance to help you do just that, with an emphasis on healthy lifestyle choices and early treatment.

Almost half of adults in the U.S. have high blood pressure, a contributing factor for heart disease, which is the leading cause of death in the U.S.

The blood pressure categories remain unchanged:

• Normal blood pressure is less than 120 mm Hg systolic and less than 80 mm Hg diastolic.
• Elevated blood pressure is 120-129 systolic and less than 80 diastolic.
• Stage 1 hypertension is 130-139 systolic or 80-89 diastolic.
• Stage 2 hypertension is 140 or higher systolic or 90 or higher diastolic.

“High blood pressure is the most common and most modifiable risk factor for heart disease,” said Dr. Daniel W. Jones, M.D., chair of the guideline writing committee and dean and professor emeritus of the University of Mississippi School of Medicine. He added that the new guideline gives patients practical tools to help them manage their blood pressure through lifestyle changes, medications or both.

The guidance reaffirms the importance of healthy lifestyle behaviors in preventing and managing high blood pressure. It also updates early treatment related to brain health, medication options and management related to pregnancy.

Healthy lifestyle habits

The guideline reconfirms the importance of healthy lifestyle choices. Here are some specific steps to help prevent and manage high blood pressure:

• Limit sodium intake to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day.
• Ideally, don’t drink alcohol. For those who choose to drink, consume no more than two drinks per day for men and no more than one drink per day for women.
• Manage stress with exercise, plus add stress-reduction techniques, such as meditation, breathing control or yoga.
• Reach or maintain a healthy weight. For adults who are overweight or obese, losing about 5% of their body weight could help prevent or lower their blood pressure. Follow a heart-healthy eating pattern, such as the DASH eating plan. The DASH eating plan emphasizes reduced sodium and a diet high in vegetables, fruits, whole grains, legumes, nuts and seeds and low-fat or nonfat dairy. It also includes lean meats and poultry, fish and non-tropical oils.
• Increase physical activity to at least 150 minutes of moderate-intensity physical activity a week. This includes aerobic exercise (such as cardio) and/or resistance training (such as weight training).
• Monitor blood pressure at home to help confirm an office diagnosis of high blood pressure and to monitor, track progress and tailor care.

Brain health

The new guideline offers stronger proof of the connection between blood pressure and brain health. High blood pressure can hurt small blood vessels in the brain, linked to memory problems and long-term cognitive decline. The guideline recommends early treatment for high blood pressure to protect brain health and to help prevent cognitive impairment and dementia in the future.

Medications

The guideline also highlights options for medications that may be needed to lower blood pressure. Many people with high blood pressure, especially those with Type 2 diabetes, obesity or kidney disease, may need two medications at once. Medications include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), long-acting dihydropyridine calcium channel blockers and thiazide-type diuretics.

High blood pressure and pregnancy

The effects of high blood pressure during and after pregnancy are also emphasized. Without treatment, high blood pressure during pregnancy can lead to serious health problems. These include preeclampsia, eclampsia, stroke, kidney problems and premature delivery.

For pregnant women with high blood pressure before pregnancy or diagnosed before 20 weeks of pregnancy, treatment with certain medications when systolic blood pressure reaches 140 mm Hg or higher and/or diastolic blood pressure reaches 90 mm Hg or higher is recommended. There is growing evidence that better blood pressure control for some women during pregnancy may help to lower the risk of serious health problems.

Postpartum care is important because high blood pressure can begin or continue after delivery. Continued blood pressure monitoring and timely treatment during the postpartum period is recommended to help prevent problems. Patients with a history of pregnancy-related high blood pressure are encouraged to have their blood pressure measured at least yearly.

Learn more about the top 10 things to know about the new blood pressure guideline.