By Charles E. Crutchfield III, MD
and J. Michael Gonzalez-Campoy, MD, PhD, FACE
In November of 2017, the American Heart Association and the American College of Cardiology issued new guidelines and definitions for the diagnosis of high blood pressure. The new guidelines are much stricter and place more than one-fourth of all Americans at risk. They changed the guidelines of having high blood pressure from anything above 140/90 to, now, anything above 130/80.
High blood pressure may cause damage to vital organs over time. Brain damage causes a stroke. Heart damage causes a heart attack. And kidney damage causes kidney failure.
High blood pressure may also damage the eyes and blood vessels, causing weakening of the blood vessel walls. If a blood vessel wall balloons out, this is called an aneurysm. Aneurysms may break and bleeding can happen.
What causes high blood pressure?
The blood pressure is determined by the amount of squeeze created by the circular smooth muscle of the blood vessels, by the speed at which the heart beats, and by the volume inside the blood vessels made up by the blood. The blood pressure will go up if there is too much squeeze from the blood vessels. It will also go up if there is an excess volume in the circulation. And it will go up if the heart is stimulated to beat faster or stronger.
Adrenaline, the “fight or flight” hormone, causes the heart to beat faster and the blood vessels to squeeze tighter. Therefore, too much adrenaline, as is the case with stress, can cause the blood pressure to go up.
Table salt has sodium. Sodium holds on to water. So, the sodium inside blood vessels will hold on to water. This increased volume will make the blood pressure go up.
Hardening of the arteries happens with aging. It comes sooner in life if you smoke. Hardening of the arteries contributes to a high blood pressure.
How common is high blood pressure?
The medical term for high blood pressure is hypertension. There are over 60 million Americans with hypertension. Hypertension affects Blacks and Hispanics disproportionately more than Whites. The new diagnosis identifies even more people as at risk.
How is high blood pressure diagnosed?
There are two numbers in any blood pressure measurement. The top number, called the systolic blood pressure, measures blood pressure when the heart is pumping. The bottom number, called the diastolic blood pressure, is the pressure when the heart is at rest. Elevation in either one of the two numbers can make the diagnosis of hypertension.
The new guidelines indicate that at least two different “careful” readings, taken at two separate times, are required to accurately evaluate blood pressure. This means a patient who comes rushing into an appointment late, battling traffic on the way in, and after consuming a caffeinated beverage is not in an ideal situation for an accurate blood pressure reading at the office.
Best to take blood pressure at home over several days with a home measuring monitor or wearable measuring monitor. Your doctor will discuss with you the best way to obtain accurate blood pressure readings. Here are where the new guidelines come into play.
If the systolic blood pressure is 140 mmHg or more, the blood pressure is considered to be high. If the diastolic blood pressure is 90 mmHg or more, the blood pressure is considered to be high. If either the systolic blood pressure or the diastolic blood pressure remains elevated over time — if the numbers were equal to or greater than 140/90 — then the diagnosis of hypertension is made.
If either one of the blood pressure numbers is equal to or above 130/80, the reading is considered to be hypertension. This causes hundreds of thousands of Americans to have the diagnosis who were not previously considered to have high blood pressure. Any consistent blood pressure reading above 130/80 is now considered to be hypertension.
Can high blood pressure be prevented?
Persistently elevated high blood pressure, which is called hypertension, is genetically programmed. It is not possible to prevent it. But the clinical onset of hypertension may be significantly delayed by keeping slim, maintaining a regular exercise program, and avoiding the use of excess salt in the meal plan.
How is high blood pressure treated?
High blood pressure is always treated with the right meal and physical activity choices. Eating more fresh fruits and vegetables, avoiding added salt, and eating less canned or processed foods is very important. These food choices limit salt intake.
Regular physical activity limits the amount of body fat and makes it easier to move. Regular physical activity also helps keep the blood vessels healthy, which in turn keeps the blood pressure down.
Persistently elevated blood pressure readings, despite a healthy lifestyle, warrants treatment with medications. Medications to lower the blood pressure may be used individually or in combinations of individual drugs.
It is very important to note that there is tremendous benefit in lowering the blood pressure with medications. This benefit is far greater than any potential risks of medications.
Recommended action steps
The most important single step to take is to measure the blood pressure. This should be done not once, but regularly over the course of your life. Awareness of a high blood pressure is the very first step to take. This is especially important if other people in the family have a high blood pressure.
Additionally, if you are an adult with high blood pressure, you should teach your children the importance of checking their blood pressure regularly. You should check it at your local pharmacy, fire station, or consider investing in a home unit. The pharmacist can recommend an appropriate home blood pressure unit for you. The key is to check it regularly and write the number down for your doctor to review at all of your visits.
Make sure you have a general medical examination once per year and more frequently if directed by your doctor. Following a healthy meal plan and taking medications as prescribed are crucial to prevent complications of high blood pressure over time.
High blood pressure has been called a silent killer. Often it is the heart attack or stroke that is the first sign of trouble. Prevention is key when it comes to high blood pressure!
Talk to your doctor to see how the new blood pressure guidelines affect you.
Michael Gonzalez-Campoy, MD, Ph.D., FACE, Mayo Clinic graduate, is medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology in Eagan, Minnesota and past president of the Minnesota Medical Association.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.