It’s vital that you understand the problem of high blood pressure in order to make the best choices regarding your health.
New Guidelines for Hypertension
By Peter N. Landless and Allan R. Handysides
The clinic nurse tells me that I have high blood pressure and should have treatment. I don’t recall the actual readings. I feel well and don’t want to take tablets the rest of my life. Is there another option? My mother was disabled by a stroke at the age of 60, and she also had high blood pressure. This is a very important question. It’s vital that you understand the problem of high blood pressure (hypertension) in order to make the best choices regarding your health.
Hypertension is known as the “silent killer.” This is because you may have raised blood pressure and not be aware of the problem. The first symptom—a stroke—may be very severe and disabling, which, sadly, happened with your mother. Your family history is worrying; we don’t know the exact cause of hypertension in most cases, but there’s good evidence to show that hypertension has a genetic component related to a number of genes. Additionally, so-called environmental factors play a part. These include smoking, alcohol, obesity, lack of exercise, and uncontrolled stress.
You need to know your numbers! By this we mean that you should have a record of your blood pressure readings so you can document changes and be managed accordingly. The guidelines for the treatment of high blood pressure have recently been revised. Blood pressure is measured with two readings, and 120/80 mm Hg (mercury) is regarded as normal. The upper reading corresponds with the pressure generated by the contraction of the heart as blood is pumped into the blood vessels and circulates around the body. The lower reading is the diastolic pressure and is maintained by the muscle activity in the smaller arterial blood vessels (arterioles). This represents the pressure in the vascular system when the heart is in the resting phase and being filled with blood for the next contraction.
Persistently elevated blood pressure results in heart muscle strain and damage, as well as damage to the blood vessels and the kidneys. The blood vessels of the brain are commonly damaged, resulting in stroke (area or areas of brain death because of the uncontrolled hypertension). Even the largest blood vessel in the body, the aorta, may be damaged and perhaps rupture. This can be rapidly fatal.
The diagnosis of hypertension is usually made on three blood pressure readings done on different occasions. This helps ensure that treatment is really needed. So, we urge you to return to the clinic to have your blood pressure rechecked and to begin needed treatment.
Treatment has two aspects: lifestyle and medication. Lifestyle changes are foundational to the treatment of hypertension. These include regular exercise, weight loss to achieve ideal weight, dietary changes, and avoidance of tobacco and alcohol. It’s been scientifically proven that a diet rich in vegetables and fruit, and low in saturated fats and salt, helps to reduce blood pressure. Exercise should be initiated in consultation with your medical advisor to ensure that it’s safe for you to engage in regular and increasing physical activity.
There are several medications for hypertension, and the guidelines advise various steps in treatment. In individuals who have moderate hypertension, two or more medications may be required. It’s important to faithfully take the medication when needed. It’s also absolutely essential to implement the lifestyle changes.
The goal: The new Joint National Committee (JNC 8) guidelines recommend that in patients over 60 years of age the goal is a treated blood pressure of less than 150/90. In patients between the ages of 30 and 59 it’s less than 140/90 mm Hg.*
We advise everyone to engage in healthful lifestyle behaviors, even if they don’t have hypertension. If hypertension is present, lifestyle changes, regular monitoring, and medications where needed are essential to prevent the unwanted and often catastrophic consequences of uncontrolled hypertension.
*JAMA. doi:10.1001/jama.2013.284427. Published online December 18, 2013.
Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department.
Allan R. Handysides, a board-certified gynecologist, is a former director of the General Conference Health Ministries Department.