One night last November, nearly half of the adult U.S. population was suddenly labeled as having high blood pressure. It happened overnight. Although nothing in people’s bodies changed, the definition of high blood pressure had been changed. And presto, 46 percent of adults were surprised to find themselves classified as having high blood pressure — compared to 32 percent only the day before. People who thought they had “normal” levels suddenly had “elevated” levels. It was as if a traffic warning light that’s always yellow had quietly turned red.
This happened because new guidelines were issued by the American College of Cardiology and the American Heart Association. Recent research led the experts to redefine high blood pressure. Science is constantly uncovering new understanding of health by using new technologies, and old definitions must fall to new research findings.
The greatest impact is expected among younger adults. According to the AHA, the changes mean that high blood pressure diagnoses could triple among men age 20 to 44 — to 30 percent of men in that age group, up from just 11 percent in previous years.
And women ages 20-44 will see their rates almost double, from 10 percent up to 19 percent.
Smoking is a leading cause of high blood pressure. Vaping can lead to high blood pressure — vaping is not safer than inhaling tobacco from a cigarette, or second-hand.
Drinking alcohol is linked too. Excessive alcohol consumption can increase blood pressure. Many large studies have reported that drinking more than three drinks per day can fuel high blood pressure.
Under the new guidelines, about three-quarters of all men age 55-74 may now be diagnosed with high blood pressure. It is predicted that Latino and black men will experience a 17 percent increase in rates. Asian men will likely see a 16 percent increase.
Many people do not even know what their blood pressure is. Although doctor visits or trips to urgent care always involve a blood pressure reading, many people do not pay attention to it or remember it.
A reading of 120/80 means 120 is the pressure in blood vessels when the heart beats, and 80 is the pressure when the heart rests in between beats. In the past, abnormally high blood pressure, also called hypertension, was anything higher than 140/90. The new guidelines lowered that, and now any reading greater than 130/80 will be treated as high. Readings above 120/80 will be considered “elevated.”
High blood pressure can be treated with lifestyle changes. “Simply changing what you eat can bring down systolic (the first number) blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points,” according to Dr. Monique Tello, a Harvard Medical School faculty member.
Prior to the new guidelines being issued, some health-care providers had initiated monitoring programs on their own. For example, Kaiser Permanente had already started a hypertension program that included regular monitoring, lifestyle changes and medication if needed, as a multipronged effort to keep it at safe levels. From 2001 to 2013, safe hypertension control within Kaiser’s monitored members increased from about 50 percent to 90 percent.
“Kaiser Permanente has been implementing monitoring that exceeds the national blood pressure control rates,” Dr. Todd A. Bryant, Kaiser Permanente Chief of Cardiology for the Woodland Hills and Ventura Service Areas, wrote to the Ventura County Reporter in an email.
“In addition, the Centers for Disease Control Prevention’s ‘Million Hearts’ hypertension program endorses Kaiser Permanente’s treatment algorithm as an evidence-based protocol to adopt,” Bryant explained. Kaiser Permanente has been recognized by the U.S. Centers for Disease Control for its hypertension treatment program, which has resulted in some of the highest blood-pressure control rates in the nation.
“The guidelines were changed because recent large population studies found that blood pressures above 120/80 put people at risk of having heart disease including chest pain, heart attack, heart failure, stroke, peripheral arterial disease or abdominal aortic aneurysm,” Bryant wrote.
“Evidence has changed since the last national guideline, the Eighth Joint National Committee (JNC8), which was published in 2014. In particular, the Systolic Blood Pressure Intervention Trial (SPRINT), which was completed in 2015, showed significant benefit for a more aggressive blood pressure goal in high-risk and older patients,” Bryant explained. The SPRINT was a National Institutes of Health project with more than 9,300 participants in clinical trials.
Ventura County Public Health data show that between 2005 and 2016, only about 16 percent of county residents under age 45 had high blood pressure. About 33 percent of those age 45-64 had high blood pressure. Using the new guidelines, the percentage of county residents under 45 headed for hypertension will increase.
For county residents 65 and older, about 52 percent were diagnosed with high blood pressure during the data collection. Ethnic differences emerge in county data as well. Latino high-blood-pressure cases comprised about 16 percent of all cases, black residents accounted for about 58 percent of cases, Asians were about 2 percent and whites were almost 33 percent.
Blood pressure can be decreased by not smoking; by eating a diet of vegetables, fruit, fish and lean meat; eating less or no sodium and salt; exercising about 30 minutes a day at least five days a week; and not drinking excessive alcohol.
Another key factor is knowing and keeping track of one’s own blood pressure. This is important because hypertension can lead to heart disease, and heart disease is the No. 1 killer of both men and women in the U.S. High blood pressure puts unnecessary strain on the arteries that serve the heart, especially if those arteries are narrowed by a buildup of fat and cholesterol.
Although it’s often thought of as a “men’s disease,” the same number of women as men die each year from heart disease. In fact, CDC data show that heart disease is the leading cause of death in U.S. women.
Men and women can have heart attacks for different reasons. These differences feed the perception that heart disease is a men’s disease.
Men with heart disease tend to have blockage in their arteries that stops blood flow to the heart, whereas women don’t always have such blockages. Instead, women might have problems in the tiny vessels near the heart. These problems are less detectable than male blockages, and sometimes women’s symptoms do not show up in typical tests, including electrocardiograms. This makes it hard to pinpoint cardiovascular disease in women.
Data from the CDC’s “Million Hearts” initiative show that more than 800,000 people die of heart disease each year in the U.S., and 160,000 of them are under 65. What the new guidelines suggest is that people are fooling themselves if they believe that only the elderly or obese are at risk. Unless a person’s blood pressure is known, they really cannot know whether their health is in danger.
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