Heart disease is one of the most prominent killers today. About 610,000 people die of this condition in the U.S. every year—that’s one in every four occurring deaths. Every year 735,000 Americans suffer from a heart attack, and 210,000 of these were not the first for those people.
High blood pressure is a key risk factor for heart disease. It is known as the “silent killer,” because unlike migraines, nausea, and other more obvious signs deeper illness, HBP doesn’t usually manifest as physical symptoms. It can only be noticed when checked by a doctor, which is why so many people live with HBP without even knowing their increased risk for a heart attack. 
Therefore, it’s imperative for patients to monitor their blood pressure once they are aware of their condition to try and control it the best they can. However, in 2017, this reading was lowered, causing an additional 31 million people to fall under the diagnosis of HBP. 
This change sparked controversy in the health field, leaving some professionals to debate whether or not this new guideline is beneficial or harmful.
What is Considered to be High Blood Pressure?
High blood pressure occurs when the force of blood flowing through one’s vessels is consistently too high. Most of the time, there are no obvious symptoms, but left untreated, this increase in pressure can lead to heart attacks, stroke, and other threatening conditions. 
Health experts created a set of guidelines to distinguish a healthy blood pressure measurement from a high one. In 2017, these guidelines changed, setting the bar lower and effectively diagnosing more people with HBP.
Here’s how it works. The previous structure considered 140/90 millimeters of mercury (mm Hg) to be too high. Since 2017, HBP is defined as a reading of 130/80 mm Hg, and anything between 120 and 129 is considered elevated. 
“Blood pressure guidelines are not updated at regular intervals. Instead, they are changed when sufficient new evidence suggests the old ones weren’t accurate or relevant anymore,” says Dr. PaulConlin, an endocrinologist with Harvard-affiliated VA Boston Healthcare System and Brigham and Women’s Hospital.
“The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it like heart attack and stroke — much earlier.”
The new numbers were established after the Systolic Blood Pressure Intervention Trial (SPRINT), which reviewed over 9,000 adults ages 50 and older who had a systolic blood pressure of 130 mm Hg or higher and at least one risk factor for cardiovascular disease.
The aim of the study was to research whether treating the patients to lower their readings to 120 mm Hg or less would be more beneficial than the standard target of 140 mm Hg. The findings showed that the patients had lower risks of heart attacks, heart failure, and strokes. 
The goal of this baseline change is to encourage healthy lifestyle habits with those on the cusp of heart issues before any real problems develop.
The new guidelines were written by a panel of 21 scientists and health experts who reviewed over 900 published studies and were issued by the American Heart Association, American College of Cardiology and nine other professional health organization. Under these new rules, 46% of U.S. adults are now considered hypertensive. 
This switch not only affects the newly diagnosed, but the U.S. healthcare system as a whole. Some people are not happy about this change. Experts say that a rise in hypertension prescription pills will result in increased costs and time spent on this treatment.
Even before the new guidelines were introduced, the expenses for hypertension treatment were rising. In 2010 alone, its direct costs totaled almost $43 billion. Analysts estimate the global market for these kinds of drugs will be $32 billion by 2020. 
Robert A. Phillips, M.D., Ph.D., Houston Methodist’s chief medical officer, investigated these new guidelines and their impact. He deduced that while high-risk patients benefit from stricter rules, low-risk patients suffer more harm than good from the recommendations of intensive treatment.
“Classifying patients by degree of future risk might be the best way to identify who could benefit most from intensive treatment,” Phillips said.
“We developed a model using the 10-year cardiovascular disease risk and found that aggressive treatment of patients with a risk greater than or equal to 18.2 percent would result in more benefit than harm, while those with a risk of less than that would fare better under a standard blood pressure management approach.” 
A report published in Jama Internal Medicine states these guidelines put patients at another risk.
Dr. Katy Bell, the lead author of the report and senior research fellow at the University of Sydney in Australia, says the new baseline follows a general pattern across medical specialties in which disease definitions are widened rather than narrowed.
“Such widened definitions usually label people as unwell, even if they are at low risk of a disease, and thus have the potential to cause harm. All of the incremental benefits and harms of the expanded definition of hypertension don’t appear to have been considered when the new guidelines were drafted.”
She found that 80% of newly diagnosed HBP patients didn’t benefit from their new label. In fact, it could cause them anxiety, depression, and other mental health issues. 
Dr. Matthew Budoff is a professor of medicine at the David Geffen School of Medicine at the University of California Los Angeles, as well as the program director of the Division of Cardiology at the Harbor-UCLA Medical Center. He believes this change is positive since it raises awareness about hypertension and spurs people to action.
“I think more people react positively with a diagnosis of something. I have several patients this week that was recently diagnosed with borderline diabetes, and they immediately started losing weight, eating better, and watching their fat/carb intake,” he says.
Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, disagrees with Dr. Bell’s statistic and favors the new baseline. He states that people with blood pressure in the spectrum of the new guideline are at risk for cardiovascular issues, and there are vital steps to take to lower this risk.
“There is clear and compelling benefit of lowering blood pressure to the levels recommended in the new guidelines in all age groups and in men and women,” he says. “The JAMA Internal Medicine analysis is misleading and does not consider the long-term benefits of achieving and maintaining recommended blood pressure levels.” 
High Blood Pressure Treatment
Nowadays, high blood pressure is conventionally treated with a variety of prescription drugs. These are effective but may come with unwanted side effects such as headaches, insomnia, fatigue, dizziness, respiratory issues, and more. 
“Once you’ve started therapies,” Dr. Joaquin Cigarroa, head of cardiovascular medicine at Oregon Health & Science University said, “you’re likely on them for the rest of your life.” 
Therefore, most doctors recommend a newly-diagnosed patient to begin with non-drug management. This treatment plan may include:
- Weight loss
- Lowered sodium intake
- The DASH diet, which includes vegetables, fruits, whole grains, fish, nuts, and other nutritious foods, while limiting unhealthy fats and sugars
- Regular exercise
- Stress reduction
- Moderated alcohol intake
These changes can suffice to lower the patient’s blood pressure to a safer range, especially if they are integrated as early on as possible. 
Natural supplements that may help this condition include :
- Folic acid
- Vitamin D
However, it’s important to consult with a trusted medical practitioner before starting or stopping any form of pharmaceutical drug or natural supplement.
Additionally, supplements may not be enough to combat a person’s risk of heart disease. It’s important to speak to a doctor about a tailor-made treatment plan and if any alternative approaches may help.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
- Heart Disease in the United States https://www.cdc.gov/heartdisease/facts.htm
- The Facts About High Blood Pressure https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure
- What’s the Impact of the New Guidelines for High Blood Pressure? https://www.healthline.com/health-news/impact-of-new-guidelines-for-high-blood-pressure#1
- Reading the new blood pressure guidelines https://www.health.harvard.edu/heart-health/reading-the-new-blood-pressure-guidelines
- Renowned cardiologist says new blood pressure guidelines not good for all https://medicalxpress.com/news/2018-03-renowned-cardiologist-blood-pressure-guidelines.html
- Incremental Benefits and Harms of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2678449?redirect=true
- How New Guidelines for High Blood Pressure Could Harm Some Patients https://www.healthline.com/health-news/how-new-guidelines-for-high-blood-pressure-could-harm-some-patients#4
- Types of Blood Pressure Medications https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications
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