Get Well Wednesday: What You Need To Know About High Blood Pressure

Dr. Rakotz currently serves as Vice President of Improving Health Outcomes at the American Medical Association (AMA), where he oversees efforts to develop and implement national quality improvement initiatives aimed at improving blood pressure control and preventing type 2 Diabetes. He is the AMA’s clinical lead of Target: BP^® – a nationwide, multi-year collaboration with the American Heart Association to reduce the number of American adults living with uncontrolled hypertension.

WHAT CAUSES HIGH BLOOD PRESSURE?
How we live our lives really has the biggest impact on our blood pressure. There are many factors that contribute to a person having high blood pressure. Getting too much of certain foods – like salt or highly processed fast foods, or drinking too much alcohol – all of these can contribute to developing high blood pressure. Also, not getting enough of some things – like fruits and vegetables that have fiber, potassium and calcium, and not getting enough physical activity, will contribute to high blood pressure.

HOW DOES HIGH BLOOD PRESSURE AFFECT THE BLACK COMMUNITY?
African-Americans are much more likely to have high blood pressure than any other racial or ethnic group in the United States. And high blood pressure can be more severe in Black men and women, and often less responsive to many medications. Compared to white adults, Black adults are almost twice as likely to die from stroke, 50% more likely to develop heart failure, and four times more likely to have kidney failure. And these conditions are largely caused by uncontrolled high blood pressure.

The American Medical Association is working with the American Heart Association on a national initiative called Target: BP, with a goal to encourage healthcare teams to prioritize blood pressure control, and provide them with the most clinically up to date tools and resources to help them achieve this across the U.S. in all communities. We are trying to decrease the negative health consequences of high blood pressure and reduce the number of deaths it causes each year.

HOW IS HIGH BLOOD PRESSURE TREATED?
Lifestyle modification – losing weight loss if overweight, eating a healthy diet, and being physically active are recommended as the first treatment started to reduce high blood pressure. And proactively engaging in these lifestyle modifications can be effective at preventing the onset of high blood pressure.

If those things don’t work, or blood pressure is so high that it is unsafe to attempt lifestyle changes alone, medication is added. Some people may need more than one medication, but the lifestyle recommendations are always continued and are considered critical to achieving blood pressure control.

WHAT ARE THE SIDE OF EFFECTS OF HAVING HIGH BLOOD PRESSURE?
Consequences of uncontrolled high blood pressure are:
Heart Attack
Stroke
Heart Failure
Kidney Disease
Sexual dysfunction
Vision Loss

WHAT ARE SOME THINGS WE CAN DO TO IMPROVE OUR BLOOD PRESSURE?
We have talked about a few already. The best time to improve blood pressure is before it gets to the point of requiring medicine to treat it.
Eat a healthy diet low in salt and processed foods and with several servings a day of fruits and vegetables and whole grains, with healthy fats and lean proteins. Also, drink alcohol in moderation if you drink – that’s one drink a day maximum for women and 2 drinks a day maximum for a man.

Try to work your way up to being physically active – the goal is brisk walking 30 minutes 5 days a week. Its ok if being physically active happens 10 minutes at a time broken up throughout the day. And remember, any activity is better than no activity.

If you do these things you will likely be able to maintain a healthy weight, or lose weight if you are overweight, which is another important thing you can do to improve your blood pressure. If you are on medication, follow the plan you have made with your doctor and stay with it. I cannot stress enough the importance staying on your plan.

WHAT IS THE NEW HIGH BLOOD PRESSURE GUIDELINE?
The American Heart Association and The American College of Cardiology, along with nine other organizations, reviewed the science and wrote the first comprehensive update for doctors to learn how to prevent, detect, evaluate and manage people with high blood pressure. The last comprehensive guideline like this was published 14 years ago, in 2003.

WHAT DOES THIS NEW BP GUIDELINE MEAN?
The new guideline redefined high blood pressure as being lower than it was previously. Now, anyone with a persistently elevated blood pressure more than 130/80 mm Hg is considered to have high blood pressure. The number used to be 140/90. This means more adults in the U.S. have high blood pressure – roughly 46% or 103 million people.

Most of the people who now have high blood pressure because of this change will be treated earlier than in the past, and the treatment for almost all of them will be lifestyle modification, not medication. The age group most affected by this will be men under the age of 45, where the number of people with high blood pressure will triple. But again, most will be treated with recommendations for lifestyle changes.

WHAT IS THE AMERICAN MEDICAL ASSOCIATION DOING TO HELP PEOPLE WITH HIGH BLOOD PRESSURE?
The American Medical Association along with the American Heart Association and the Ad Council are raising awareness about high blood pressure for all adults in the U.S. by launching a new Public Service Awareness campaign that reminds viewers of the serious, life-threatening consequences of uncontrolled high blood pressure and that they should take urgent action by speaking with their doctor to create or modify their treatment plan together.

Viewers are directed to create or update their plan with their doctor and to visit LowerYourHBP.org for resources on how to understand your blood pressure numbers and the risks of high blood pressure sources to manage their plan. You can also download a printable worksheet that provides a structure of what to do before, during, and after an appointment with your doctor to help you create a personalized high blood pressure treatment plan

The AMA is also working with physicians and healthcare teams to prioritize blood pressure control across the U.S. through a joint initiative with the American Heart Association called Target: BP. Target: BP offers blood pressure improvement tools, resources, and expert staff to help medical offices, health centers, and healthcare organizations improve their skills, and also provides them with resources to help the patients they serve. So we are working with both patients and their doctors to try to get high blood pressure under control.

Dr. Rakotz answers your questions on the next page.

I have hypertension, I don’t eat salt, but now my doctor wants me to eat salt because my iodine levels are low. Isn’t that backward?

Salt provides only a fraction of daily iodine intake for most people. Iodine comes from many other foods and supplements. Talk with your doctor about this. Also visit our new dedicated website, LowerYourHBP.org, with resources to help you understand your blood pressure numbers, access healthy lifestyle resources and prepare to discuss blood pressure with your doctor.

Medications for high BP tends to make the patients face swell… what are those meds? My wife won’t take her meds because of it.

Some medication classes, “Calcium Channel Blockers” and “ACE Inhibitors” are two classes of medications can do this. If facial swelling occurs, call your doctor. They are many alternatives that shouldn’t do that.

What would be the best blood pressure home meter?

We don’t endorse any one brand or model, however, we do recommend using only upper arm devices that are automated, clinically validated, and have memory storage. Talk to your pharmacist or doctor if you have questions. Most BP monitors in the U.S. are sold in pharmacies so they can make sure the device is the right size and is clinically validated.

What are the long-term side effects from the medication?

Most blood pressure medications are safe and the long-term effects are preventing heart attacks, strokes, kidney disease, and heart failure. For most, the health benefits greatly outweigh the side effects that some people can have. Some people have allergies to specific medications, and some can develop swelling in the lips, face, or legs. Most medications, however, are extremely well tolerated. Talk to your doctor if you are concerned

I did not hear WHY the ratings changed for high blood pressure. Can he explain that better?

Blood pressure risk starts to rise at blood pressures between 110-115 / 75-80 and double every 20/10 mm Hg above that, but under the previous guideline, high blood pressure wasn’t diagnosed until BP reached 140/90. The threshold was changed to 130/80 based on new evidence as well as the idea that recognizing high BP earlier and initiating lifestyle changes for most people will have benefits (even if medication is not started until 140/90 in low-risk people).

So to summarize – the reasons are: to diagnose high BP earlier, in order to get more people treated and thereby lower their risk of suffering consequences of high BP (heart attacks and strokes and heart failure) by starting treatment sooner, mostly lifestyle changes that we discussed in the interview, and sometimes medication at this new lower level.

What about red wine? Can it  lower high blood pressure?

Alcohol should not be started as a treatment for someone who doesn’t drink. Although there may be some health benefits of drinking a glass of wine a day (or other alcohol) in people who drink, it is not recommended as a treatment for high blood pressure. More than a drink a day in women can worsen high blood pressure, and more than two drinks a day in men can worsen high blood pressure. A drink is considered a glass of wine, a beer, or a shot of hard alcohol.

Doctor, does sleep apnea affect blood pressure? Is a sleep study recommended?

Yes. Sleep apnea is a common contributor to high blood pressure and anyone suspected of having sleep apnea should have a sleep study.

Lately, when monitoring my BP it’s been high. Could it be related to the dental problem I’m having? My appointment with the dentist is next week.

Yes. Good dental hygiene is very important, and pain, in particular, can increase blood pressure, as well as worrying about a health problem. I should caution you that you should follow up when the dental problem is cleared up to make sure that you haven’t developed high blood pressure that is unrelated to your dental problem and you need additional treatment. So make sure you follow up and have your blood pressure checked when the dental problem is resolved.

What do you do if you’re maintaining a healthy lifestyle but your numbers are still high? They fluctuate, one day low, the next day high and your on several different medications what do you do?

This is where it is important to work with your doctor to make a plan. There are ways to self-monitor your blood pressure at home, and if you are already doing that you might be a good candidate for a 24-hour ambulatory BP monitoring test that will track your BP every 15-20 minutes for 24 hours, including sleep. Your doctor can talk to you about this test.

Does vinegar lower blood pressure?

There are no scientific studies that have shown that vinegar is an effective way to lower your blood pressure, although it is a commonly used home remedy. Make sure your doctor knows that this is part of your plan, and don’t stop your medication if you are on it unless you are told to do so by your doctor.

Will you please provide a perspective on the connection between antiseptic mouthwash and HBP plus diabetes?

A recent article did raise the question about using mouthwash twice a day – participants in the study using mouthwash twice daily were twice as likely to develop diabetes than those who didn’t. And the risk only occurred if the mouthwash was used twice daily or more. However, these people were at high risk for developing diabetes already. Between 70% and 80% of people with diabetes do have high blood pressure, so if diabetes developed in these people, they may also have high blood pressure.

But in this case, it would be diabetes having an association with high blood pressure, not mouthwash causing high blood pressure directly. There are some preliminary studies questioning a link between mouthwash impacting bacteria in the body which could raise high blood pressure. It is too early to say for sure, but we cannot say it isn’t a factor either. More studies need to be done.

Regarding blood pressure, the doctors here in Milwaukee have said when people get over 65 the top number should be between 130 to 150. My mom has been on medication for over 50 years and now her kidneys are declining.She’s 81. Is this true?

With declining kidney function, this can be more complicated than a simple guideline recommendation. Although the AHA/ACC Guideline for High Blood Pressure recommends a treatment target for people with kidney disease and people over age 50 to be <130/80, this varies depending on what type of kidney disease and the severity.

So it is very important that her doctor manages her blood pressure based on her individual situation. Clinical judgment by a doctor is more important for each individual than a blanket guideline statement for the entire population. As doctors, we have to treat everyone individually.

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