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November 17, 2017

Half of Americans now have high blood pressure. Here's how to lower yours.

Daily Briefing

    Under new blood pressure guidelines from the American Heart Association and the American College of Cardiology, millions more Americans now qualify as having high blood pressure—but there are steps you can take to lower yours, Gina Kolata writes for the New York Times.

    How do you know if you are at risk?

    According to Kolata, the new guidelines state that anyone with at least a 10% risk of stroke or heart attack in the next decade should seek out treatment for high blood pressure. To calculate your risk, Kolata recommends the online calculator suggested by the new guidelines.

    However, Kolata explains that blood pressure readings can fluctuate significantly based on the time of day, your level of physical activity immediately preceding a test, and various other factors. As a result, the new guidelines call on providers to measure a patient's blood pressure several times on multiple occasions to get an appropriate average.

    What happens if you have high blood pressure?

    In fact, if an individual does have high blood pressure at the doctor's office, Kolata recommends he or she measure it at home several times over 24 hours. Physicians may also give patients with a high blood pressure reading an arm cuff that measures pressure at intervals over the course of the day.

    Kolata adds that some people have "masked hypertension"—a condition/phenomena in which their blood pressure may seem fine for one reading and then surge to dangerous levels on the next one. According to Raymond Townsend, the director of the hypertension clinic at the University of Pennsylvania, "no one knows what to do about" masked hypertension. "We don't have any information on the value of treating it but we know it is not good to have," he said.

    Kolata also points out that some drugs have the ability to raise blood pressure, including:

    • Amphetamines;
    • Alcohol;
    • Decongestants;
    • Herbal supplements;
    • Non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen; and
    • Steroids.

    Ways to treat high blood pressure

    According to Kolata, there are two main ways to treat high blood pressure: Lifestyle changes and medication.

    Lifestyle changes include strategies such as losing weight, going on a diet, and exercising. However, Kolata cautions that "individuals vary in how they respond to lifestyle changes alone."  

    If lifestyle changes are ineffective or difficult to implement, there are also several medical approaches, Kolata writes. According to Kolata, there are five main therapies for treating high blood pressure:

    • ACE inhibitors, which relax blood vessels. However, the medication causes a dry cough or high levels of potassium in the blood, which can be dangerous, in about 10% of patients;

    • Angiotensin II receptor blockers (or ARBs), which use a different approach than ACE inhibitors to relax blood vessels. However, according to Kolata, they can also lead to high potassium levels;

    • Dihydropyridine calcium channel blockers, which prevent blood pressure constriction but can cause constipation and the mild swelling of hands and feet in about 5% to 10% of patients;

    • Diuretics, which curb blood sodium levels and decrease blood volume. However, they can potentially lower sodium too much, which poses a particular risk for older, thin women; and

    • Non-dihydropyridine calcium channel blockers, which take yet another approach to addressing blood vessels, Kolata writes. However, these blockers can potentially cause constipation and, in rare cases, alter electrical conduction in the heart—a condition that if left unnoticed can cause the upper part of the heart to beat apart from the lower part.

    It's also possible that these drugs won't work, either because people simply don't stick to their medication regimen or because they do not respond to—or cannot handle the side-effects of—treatment. Among the latter group, which accounts for about 3 to 5% of people with high blood pressure, Townsend recommends they pick the least problematic drug and enroll themselves in a clinical trial that's testing a potential alternative. "If we don't do anything for these people, we know they will be in trouble," Townsend said (Kolata, New York Times, 11/15).

    Learn more

    To learn more about care management best practices, download our research report, “Blueprint for Cardiovascular Care Management.”

    Download the Report

    To learn more about how managers can help frontline clinicians tap into patients' motivation to change, download our toolkit, “Motivational Interviewing 101.”

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