New guidelines lowered the standard for high blood pressure, but treatment should consider other conditions, physicians say. Do you have high blood pressure (also called hypertension)? At my annual visit to my cardiologist last week, my reading was 110 millimeters over 80 millimeters (110/80). According to the American Heart Association, blood pressure readings are the ratio of “systolic” pressure — or peak blood pressure (the heartbeat) caused by the heart muscles’ repeated contraction to continuously pump oxygenated blood throughout the body, the first number — to “diastolic” pressure (the second), when the heart relaxes between heartbeats. The relaxing action minimizes blood pressure lower than systolic pressure, creating a vacuum-like effect that acts to suck up into the heart the combination of blood freshly made by bone marrow (the soft fatty tissue inside bone cavities) and blood that has already circulated and finished donating its oxygen to the organs. The heart then pumps that blood to the lungs to gain oxygen. Heart muscles then relax to bring back the newly oxygenated blood, and the heart again pumps it out, repeating the cycle. My reading is good under new medical guidelines issued in November, which lowered the threshold for hypertension (set 15 years ago) from 140/90 to 130/80. Exceeding the threshold generally means you need medication to fend off the ravages of heart disease. “Nearly half of American adults have high blood pressure,” the AHA says. “Many don’t even know it.” There are no obvious symptoms, but, when untreated, high blood pressure can “damage your circulatory system, put undue pressure on the heart, and lead to heart attack, stroke, and other health problems.” What causes high blood pressure? “There’s no identifiable cause,” says the Mayo Clinic’s website, but factors include smoking (which narrows arteries, increasing the pressure to push blood through them), excess salt intake (which causes fluid retention and increases blood pressure), excessive alcohol intake, age, obesity (requiring more blood to supply oxygen and nutrients), sleep apnea, and stress. Treating high blood pressure under the new threshold may be dangerous, some cardiologists and researchers say. Under the new standard, the estimated percentage of U.S. adults with hypertension rose from 32 percent to 46 percent, the Feinstein Institute for Medical Research says. In a February article in the Journal of the American College of Cardiology, Feinstein researchers said that as many as 10 million adults with a low hypertension risk could be getting unneeded medication under the new guideline. In a separate article in the journal, cardiologist Dr. Valentin Fuster, physician-in-chief at the Mount Sinai Hospital, said treatment for patients younger than 65 and without other risk factors, such as diabetes, could begin when their blood pressure reaches 140/90. Fuster wrote that he had heard from several patients who had experienced lightheadedness and fatigue after takingsteps to reduce their blood pressure below 120/80. My cardiologist, Dr. Arshad Yekta, agrees that strictly following the guideline could be dangerous. “Blood pressure needs to be individualized so using a fixed number of 130 over 80 for all comers may not be in their best interest,” he said. Physicians should consider other risk factors, including age, he said. Of greatest concern, Fuster wrote, is that 15 percent to 30 percent of Americans with high blood pressure don’t know it. So, get your blood pressure checked regularly ... and discuss your individual issues with your doctor. Source
