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etables, whole grains, potassium, calcium and magnesium, while low in sodium and fat (
https://www.nhlbi.nih.gov/health-topics/ dash-eating-plan) — is “particularly con- structed to lower blood pressure.” Avoiding excess intake of sodium and
increasing potassium, which helps the body excrete sodium, are key elements to any diet designed to lower blood pressure, he says. Reducing alcohol consumption can also
help lower blood pressure, says Dr. Whelton. “If you drink, your blood pressure will go up,” he says. However, because moderate alcohol consumption has been shown to beneficially impact lipid profiles and raise HDL cholesterol, the guidelines allow for two drinks per day for men and one for women. “Those are the nonpharmacological ap-
proaches that everyone should take,” says Dr. Whelton. “But as your pressure climbs up and gets closer to the cutpoints for hyper- tension, you have to take it more seriously. Prevention is always better than treatment.” The new guidelines place blood pres-
sure levels into five categories, eliminating prehypertension. Normal: systolic less than 120 mmHg and diastolic less than 80 mmHg. Elevated: systolic 120-129 and diastolic less than 80. Hypertension, Stage 1: systolic 130-139 or diastolic 80-89. Hypertension, Stage 2: systolic at least 140 or diastolic at least 90. Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. Medication is not recommended for people in the “elevated” category, says Dr. Whelton. Nor is it recommended for every- one in Stage 1.
“In terms of making a decision about
whether to treat with medication, we suggest an approach that’s different than before,” he says. “We say all patients with hypertension should have an assessment of their underlying atherosclerotic cardiovas- cular risk to see if it’s high. We look at whether they’ve had a previous stroke or a heart attack. If they have, they are at high risk for a second event and should be treat- ed with medication. If they have not, we put their risk factors into a risk calculator and it will predict their chances of having an event in the future. If that risk exceeds ten percent over the next ten years, we con- sider that high and that person should be on medication.” Dr. Whelton says people can calculate
their own risk using an online tool. One to try:
http://www.acc.org/tools-and-practice- support/mobile-resources/features/2013- prevention-guidelines-ascvd-risk-estimator. Adults over the age of 65 and those with diabetes or chronic kidney disease are au- tomatically considered high risk and should be treated with medication if their blood pressure exceeds the normal range, he says. Medication is also beneficial for those with stage 2 hypertension. Dr. Whelton noted that some people with
high blood pressure do not test high in their provider’s office but do show elevated levels at home. Therefore, he recommends that people test regularly at home and provide this data to their healthcare team. “This is called masked hypertension, and
it’s relatively common,” he says. “It’s hard to get an exact number,” so it’s important to monitor blood pressure in more than one setting and look at the overall pattern, which requires help from the patient. “The clinician is there to provide advice and make recom- mendations for treatment,” he says, “but at the end of the day, the patient is the most important person on that team.”
18 | MATTERS OF HEALTH
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