New guidelines (the first comprehensive set since 2003) lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention.

“High blood pressure should be treated earlier with lifestyle changes, and in some patients with medication at measurements of 130/80 mm Hg rather than 140/90 – based on new ACC (American College of Cardiology) and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure.”

The new guidelines (the first comprehensive set since 2003) lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under age 45, the guideline authors note.

Risk of cardiovascular complications

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.” However, only a small increase is expected in the number of adults requiring antihypertensive medication.

Dr. Ahvie’s Comments:

While the public health messages will now be more clear, it is highly likely that doctors will not have the tools or time to discuss “non-drug approaches” such as diet, exercise, relaxation techniques and other lifestyle modifications. There are many reasons for this. One is that most doctors don’t often practice these guidelines! Another is they don’t have support systems in place, such as life coaches and nutritionists, to advise patients in enough detail to make a real difference. So, many millions more patients will likely go on to anti-hypertensive medications and, over the next few decades, we will wait and see whether the risk-benefit is favorable. And, we will continue to be told that the Food Pyramid is still a valid scientifically based food strategy!

Lobbying for cardiovascular prevention

When I directed the Ischemia Research and Education Foundation in San Francisco from 1995-2000, I went to Congress to lobby for cardiovascular prevention, and received smiles and laughter from members of Congress on ideas to incentivize the public to reduce their weight and blood pressure by tax incentives, and to create time during hospitalizations for training, both patient and family members, on how not to prevent a second heart attack or need for a second bypass surgery. The message I received was, “This is not going to happen young man!”

Patient in PET scanner

Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels.

We all know that preventive medicine provides the best future for society. To be optimized, everyone should undergo regular testing, and to learn which components of our biological systems are strongest and which are weakest. Replace what you are depleted in, take the right supplements that support detoxification and metabolic pathways that keep you in repair mode, eat a clean diet rich in good fats and low in carbohydrates, exercise and keep your weight reasonably down, and have some strategy for relaxation, and more than 95% of the population will never develop hypertension, even if it runs in the family.

This is why a functional approach to Integrative Medicine is so important. None of us are an “average” patient. None of us will know whether the estimated 30% efficacy rates of most approved drugs will work on us. None of us will be able to measure our true risk of some disease with great accuracy, with or without our 23&Me results. What we do know is, if we prioritize our health, wish to prevent disease and optimize for graceful aging, then we need to listen about our body everyday. To do so intelligently, you will benefit from finding the best guides who are passionate, who “walk the walk”, and who are dedicated to continuous learning. That is why I left the mountain-top at UCSF to start Anatara Medicine, to learn and to grow along side you.

Happy Holidays!

Dr. Ahvie Herskowitz

Related articles:

New Blood Pressure Guidelines

New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension