New Views on Blood Pressure

By Dr. Kelly McGrath

Early in my career, before I moved to Idaho, I was working a busy ER shift when a 37-year-old male came in with chest pain. Checking his EKG, it was apparent he was having a serious heart attack. He received aggressive care and ultimately did well. It easily could have turned out much worse. At that time, I was in my early 30s and was pretty shocked to see someone close to my age having a heart attack. At first glance, it did not appear that he had any risk factors for the heart attack. He did not have high cholesterol, diabetes, family history of heart disease and was not a smoker. When I looked at his chart however, I saw a decade of elevated blood pressures that had never been treated. The patient and his doctor had blamed each elevated blood pressure on stress; no treatment or lifestyle modification occurred as a result. This was a valuable lesson to me to not ignore blood pressure that was repeatedly elevated. Ignoring high blood pressure is dangerous since it is a key driver of heart disease (the #1 killer in the United States), stroke and kidney disease. I liken it to not changing the oil in your vehicle. It may run great today if you don’t change the oil but, in time, it won’t. The same applies to high blood pressure.
Although the definition of hypertension (high blood pressure) for many years has been a blood pressure consistently greater than 140/90, recent evidence shows that we should use a lower threshold of 130/80 for blood pressure since this is where the risk really starts. In fact, the American College of Cardiology and the American Heart Association now recommend that treatment of high blood pressure should begin at the 130/80 level or above. Often, treatment can be as simple as adopting a healthier lifestyle. Not everyone needs medication to improve the blood pressure.
Under the new definition, between 45% and 50% of all adults have high blood pressure that needs to be controlled. Unfortunately, only half of those people not even know that they have elevated blood pressure.
It Is recommended that if you have not had your blood pressure measured over the past year, you should have it checked by purchasing a home monitor, attend a blood pressure screening event or just showing up to the clinic for a blood pressure check which is a no charge visit. If your blood pressure is greater than 130/80, it makes sense to check that again in about a week. If it is still elevated, it likely needs to be addressed either by lifestyle modification or possibly with medications.
One way to improve high blood pressure without using medications is to follow a low sodium (low salt) diet. It is recommended that we have less than 2000 mg of sodium in our diet each day. Adding fruits, vegetables, lean protein, whole grains and by selecting foods rich in potassium we can lower blood pressure. Maintaining a healthy weight, being physically active, moderating alcohol intake and stopping smoking can all have positive effects on blood pressure.
If medications are required, most people’s blood pressure can be treated with low-cost medications. In the end, it is important to know what your blood pressure is and, if necessary, take steps to improve control so you can have a long life free of cardiovascular disease or stroke. You would not run your vehicle for years without changing the oil so treat yourself as well as you treat your car and get a blood pressure check.