What's (relatively) new with blood pressure

Here’s a clinical scenario: a cheerful and pleasant 42 year old male comes into my office, looking to establish care with a primary care doctor, because he’s heard from his friends and family that, “it’s time you get a checkup and start taking care of yourself.”  After talking with him for 30 minutes, I find out he’s single, lives with his dog in a small home in the city, and is a social butterfly.  He’s a business analyst who works 50-60 hours a week in a high-stress job, and vapes marijuana and drinks alcohol as a form of release on the weekends.  He is pretty satisfied with his life, and can really see no major improvements he needs to make.  Upon taking his vitals, he is about 30 pounds over his ideal weight for his height, and his blood pressure is 135/85.  According to the new guidelines given to physicians, he is considered Stage I high blood pressure, and is a candidate for medication.

In November 2017, the American Heart Association (AHA), in conjunction with the American College of Cardiology (ACC), established new benchmarks for cardiovascular health.  The revised guidelines are meant to bring to light risk factors which might arise sooner than would be noted with the older guidelines.  Below you will find a table comparing the 2014 position with the 2017 position:

 

2014

2017

Normal

<120/<80

<120/<80

Elevated

None

120-129/<80

Pre-hypertension

120-139/80-89

None

Stage I

140-159/90-99

130-139/80-89

Stage II

>160/>100

>140/>90

Hypertensive crisis

>180/>110

>180/>120

 

According to the joint position paper put out by the AHA and the ACC, these new guidelines will result in about half of the American population (46%) being considered to have high blood pressure, with the younger population being the most affected, as in the clinical scenario listed above.  There is definitely merit in revising these numbers, as it will prompt patients to be more aware of their health, and start taking measures to improve things like diet and lifestyle at an earlier point.  On the flip side, it is this author’s opinion that medication should only be considered with the new Stage I numbers if there are comorbidities that exist, such as type 2 diabetes and chronic kidney disease, which have been shown to exponentially increase a person’s risk for a cardiovascular event.  Many times have I witnessed a drop in blood pressure with a simple change, such as improving a person’s quality of sleep. Your body detoxes and heals itself during the nighttime hours, so by optimizing sleep, you have a greater chance of decreasing the inflammation that can lead to higher blood pressure numbers. 

When I first read the new guidelines, I was skeptical, as the changes led me to believe that more people would be “forced” onto medication.  But upon further thought, I believe this will get more people into their doctors’ offices to discuss what kinds of things can be done to lower and minimize risk of heart attack and stroke at an earlier time.  From a naturopathic perspective, lots can be addressed with the gentleman in the above scenario – things like diet, exercise, sleep, stress level, digestion, and enjoyment in life.  My hope is that primary care physicians will start to look at things in a more holistic manner, and see what can be done before putting someone on medication at the new lower limits. 

Author
Dr. Vanessa Wilkie, ND Naturopath and health advocate

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