New blood pressure guidelines - what you may not hear from your doctor

I’m not suggesting that there’s a sinister conspiracy to hide anything. Not at all. It’s just that doctors often have more problems to sort out than time to do it. They can only focus on so much at one office visit. Blood pressure that is somewhat elevated but not yet high enough to label as hypertension and treat with medication doesn’t always make the cut.

If it does, you’re likely to get a cursory “Cut back on the salt,” or “Try to get more exercise,” but little in the way of practical support for making lasting changes.

Managing blood pressure is about more than just hiding the salt shaker.

New Blood Pressure Definition

I wonder if this is the real reason the American Heart Association (AHA) and American College of Cardiology (ACC) changed the cutoff for hypertension from 140/90 to 130/80 in their new guidelines — to get people to address this risk factor earlier in the game.

(The stated reason is that risk of cardiovascular health problems rises continuously with blood pressure once it gets above about 120/80, including heart attacks, angina, heart failure, stroke, peripheral artery disease, and abdominal aortic aneurysm. See below for their new blood pressure categories.)

Now before you run off to the nearest drugstore to check your blood pressure and panic, keep in mind that they’re talking about properly measured blood pressure, done with your doctor’s help.

But Not in Canada

And not everybody is in agreement with the new definitions. Hypertension Canada reviewed the same studies but decided not to endorse the new guideline, and the American Academy of Family Physicians did the same. Their reasons boil down to a debate about benefit versus risk of treating hypertension (by which they mean with medication) to these lower targets.

There is general agreement, however, that blood pressure above 120/80 but below 140/90 confers some increased risk. Hypertension Canada calls it “moderate” risk, vs “high” risk at or above 140/90. (See below.) This range has also been called “high normal” or “pre-hypertension,” and that isn’t new.

(Note that if you have diabetes or are otherwise deemed to have high cardiovascular risk, your doctor may already be recommending treatment at 130/80.)

Practically speaking, this shouldn’t change treatment much. Both guidelines suggest that we try health behaviour change first. The ACC says that “only a small increase is expected in the number of adults requiring antihypertensive medication.”

What Might Not Get Addressed

However, in my experience, blood pressure often doesn’t become a priority for busy docs until it is consistently high enough to consider medication. Many don’t put much stock in health behaviour change, in part because they don’t have the time or training to provide effective counselling, and in part because it’s hard for their patients to do.

That’s unfortunate. I like to think of that moderately elevated blood pressure as a precious opportunity to possibly avert a serious health problem down the road.

(That’s why I hosted a free 10-day blood pressure challenge in February for Heart Month, and we’ll do it again in May for Hypertension Month. So sign up now if you’d like to be notified when we kick it off.)

Non-drug remedies take more effort, but they have positive side effects, after all. And you don’t have to eat food that tastes like cardboard. If you take the time to learn and experiment, you’ll discover that blood pressure-friendly food can be delicious and yep, even convenient.

The debate is about when to use medication and how low to aim. But no one debates the benefit of heart-healthy eating, exercise, and other blood pressure lowering habits. Yet all too often they just give them lip service and move on.

So what can you do?

Check Hypertension Canada’s list of blood pressure lowering health habits. Is there one you want to work on?
If it’s food-related, ask your doctor for a referral to a dietitian. Many offices, in Calgary at least, can now link you up with one for free. Then you can get some individualized guidance and support.
If exercise is your focus, ask your doctor for a referral to Alberta Healthy Living’s free supervised exercise program for people with chronic health conditions (daytime only).
Or, check out the free classes offered by Alberta Healthy Living, including Cholesterol and Blood Pressure Essentials, Living Well with Stress, Waking Up to Healthy Sleep, and more. The classes are taught by a registered dietitians, registered nurses, or psychologists, as appropriate. Some classes are even offered in Cantonese, Mandarin and Punjabi.
Sign up for my updates. I just developed a blood pressure talk for a client, and one day soon (when I have time to figure out how!) I plan to offer it via a free webinar.

We may not be adopting the new AHA/ACC definition of hypertension in Canada, but that doesn’t mean that these lifestyle approaches aren’t worth doing now, no matter what your blood pressure.

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