Getting to the heart of the new hypertension guidelines
January 20, 2004 | 12:00am
There’s no getting around it, high blood pressure is a killer. It’s a strong risk factor for cardiovascular disease (including heart attack, heart failure and stroke), kidney disease and dementia. High blood pressure (hypertension) affects millions of Filipinos and many don’t even know they have it. There are many people who do know they are hypertensive, but they do not seek treatment as they feel their blood pressure is only "slightly elevated."
To update previous guidelines, the US National Heart, Lung and Blood Institute appointed a group of experts to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Its findings, published in the Journal of the American Medical Association, were based on an in-depth review of studies since 1997. The new guidelines will have a profound effect on how blood pressure is defined and treated.
The JNC 7 Report provides stricter guidelines, specifically that normal blood pressure should now be less than 120/80 millimeters of mercury (mmHg). A diagnosis of hypertension is based on the average of two or more blood pressure readings taken on each of two or more visits to your doctor. Average blood pressures of 140/90 mmHg and higher are considered hypertension. (See chart for the new classification.)
The message from the experts is essentially this: Take early action before your blood pressure climbs any higher – and into the range where the risks of heart disease, stroke, and other health problems become pronounced. Indeed, research findings support their recommendations. Several studies have shown that cardiovascular risks actually start climbing at 115/75 mmHg – not 140/90. And starting at 115/75, the risk doubles for each 22 mmHg increase in the systolic pressure and each 10 mmHg increase in the diastolic pressure.
The JNC 7 also found that:
• People with a systolic blood pressure of 120 to 139 mmHg or a diastolic blood pressure of 80 to 89 mmHg should be considered prehypertensive because they often progress to hypertension. This is a new category for which healthy behaviors may prevent hypertension and cardiovascular disease.
• For people older than 50, systolic blood pressure (top number) greater than 140 mmHg is considered an extremely critical and more important risk factor for cardiovascular disease than is an elevated diastolic blood pressure (bottom number).
• For people 40 to 70 years of age, each increase of 20 mmHg in systolic blood pressure or 10 mmHg in diastolic blood pressure doubles the risk of cardiovascular disease.
The benefits of lowering blood pressure include reductions in stroke of 35 to 40 percent, reductions in heart attacks of 20 to 25 percent, and reductions in heart failure of more than 50 percent.
Treatment of high blood pressure starts with healthy life choices, which are important for people with normal blood pressure, too. This includes the following approaches:
• Adopt the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH eating plan is rich in fruits, vegetables and low-fat dairy foods, and is low in salt, animal (saturated) fat, total fat, and meat and sweets.
• Restrict dietary sodium intake to no more than 2,400 milligrams (mg) a day, the amount in 1 teaspoon of salt. Dropping to 1,500 mg is even better.
• Lose weight if overweight. Losing just 10 pounds can make a difference.
• Increase physical activity to 30 to 60 minutes a day.
• Limit alcohol consumption to no more than one alcoholic beverage a day.
If adopting a healthy lifestyle isn’t enough to bring your blood pressure under control, you may need to take a blood pressure-lowering medication. The general goal of treatment when medicine is used is to bring down your blood pressure to less than 140/90 mmHg. For those with diabetes or kidney disease, the goal is less than 130/80 mmHg.
Once you’re taking medication for blood pressure control, see your doctor on a regular basis to review your treatment program. Taking your own blood pressure at home can also help. Maintaining your goal blood pressure should be a top health priority.
The DASH diet is low in saturated fat, cholesterol and total fat, and emphasizes fruits, vegetables, and low-fat dairy foods. It includes whole grains, fish, poultry and nuts, and lesser amounts of red meat, sweets, and sugary beverages. The diet is also rich in magnesium, potassium and calcium, minerals needed to control blood pressure. Not only does it help people with mildly elevated blood pressure get their numbers down to a healthier range, it also enables people to avoid medication or to lower the amount of antihypertensive drugs they are taking. And if you need to lose weight, the DASH diet can be adapted to help you achieve the goal as well.
The DASH eating plan calls for 4-5 servings a day each of fruits and vegetables (a serving would be a medium apple or 1/2 cup of cooked vegetables), 2-3 servings of low-fat dairy foods (such as 8 oz of 1 percent milk), and 7-8 servings of whole grains a day (one serving is a single slice of whole wheat bread or 1/2 cup of pasta). Bonus: The lower the fat content, the more calcium they contain. Limit meat, poultry, and fish to two or fewer servings (and choose leaner cuts of meat and fish rich in healthful omega-3 fats, such as salmon).
The number of servings is determined by calorie-intake ranges that depend on your weight and how active you are. For example, a moderately active woman who weighs 140 pounds would need just over 2,000 calories a day (see chart for food servings). If you need to lose weight, you would move to the lower 1,400-1,800 calorie range.
"If you reduce your intake by around 500 calories a day, that’s a good strategy for losing a pound a week. All you need to do is adjust the number of servings in each food group," explains DASH researcher Laura Svetkey, M.D., director of the Hypertension Center at Duke University in Durham, North Carolina.
While some diets have you cut back or eliminate specific foods, the DASH plan does not. "It’s the overall eating pattern you want to maintain, but at a lower level of calories. We can’t say whether the fruits are more important than the grains, or the dairy is more important than the vegetables. We tested the basic eating pattern. We do know that it lowers blood pressure, and therefore we recommend it," says Dr. Sevtkey.
You get more salt-sensitive as you age, so aim for less than 2,400 mg of dietary sodium a day (about a teaspoonful). Even if you don’t add extra salt to food, many processed food products (and even frozen vegetables) contain sodium. So read labels carefully for sodium content. Limit alcoholic beverages to one or fewer drinks a day.
Why does the DASH diet lower blood pressure so effectively? One recent study suggests it may act as a natural diuretic. Writing in the journal, Circulation, Japanese and US researchers say the diets’ high mineral content can help the body get rid of excess salt – just as diuretic drugs do. (Under the new guidelines, diuretics are the first line of therapy for most people with high blood pressure.)
Another randomized trial, published in Lancet, the British medical journal, found that people who ate more fruits and vegetables increased their blood antioxidant levels and lowered their blood pressure. Studies have shown the DASH diet can also lower cholesterol and enhance the effectiveness of some blood pressure drugs.
"This is also a diet high in calcium, which can help prevent osteoporosis. So if you want to eat healthy, this is a good way to do it," concludes Dr. Svetkey.
For more information on the DASH diet, log on to www.nhibi.nih.gov/health/public/heart/hbp/dash.
To update previous guidelines, the US National Heart, Lung and Blood Institute appointed a group of experts to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Its findings, published in the Journal of the American Medical Association, were based on an in-depth review of studies since 1997. The new guidelines will have a profound effect on how blood pressure is defined and treated.
The JNC 7 Report provides stricter guidelines, specifically that normal blood pressure should now be less than 120/80 millimeters of mercury (mmHg). A diagnosis of hypertension is based on the average of two or more blood pressure readings taken on each of two or more visits to your doctor. Average blood pressures of 140/90 mmHg and higher are considered hypertension. (See chart for the new classification.)
The message from the experts is essentially this: Take early action before your blood pressure climbs any higher – and into the range where the risks of heart disease, stroke, and other health problems become pronounced. Indeed, research findings support their recommendations. Several studies have shown that cardiovascular risks actually start climbing at 115/75 mmHg – not 140/90. And starting at 115/75, the risk doubles for each 22 mmHg increase in the systolic pressure and each 10 mmHg increase in the diastolic pressure.
The JNC 7 also found that:
• People with a systolic blood pressure of 120 to 139 mmHg or a diastolic blood pressure of 80 to 89 mmHg should be considered prehypertensive because they often progress to hypertension. This is a new category for which healthy behaviors may prevent hypertension and cardiovascular disease.
• For people older than 50, systolic blood pressure (top number) greater than 140 mmHg is considered an extremely critical and more important risk factor for cardiovascular disease than is an elevated diastolic blood pressure (bottom number).
• For people 40 to 70 years of age, each increase of 20 mmHg in systolic blood pressure or 10 mmHg in diastolic blood pressure doubles the risk of cardiovascular disease.
The benefits of lowering blood pressure include reductions in stroke of 35 to 40 percent, reductions in heart attacks of 20 to 25 percent, and reductions in heart failure of more than 50 percent.
Treatment of high blood pressure starts with healthy life choices, which are important for people with normal blood pressure, too. This includes the following approaches:
• Adopt the Dietary Approaches to Stop Hypertension (DASH) eating plan. The DASH eating plan is rich in fruits, vegetables and low-fat dairy foods, and is low in salt, animal (saturated) fat, total fat, and meat and sweets.
• Restrict dietary sodium intake to no more than 2,400 milligrams (mg) a day, the amount in 1 teaspoon of salt. Dropping to 1,500 mg is even better.
• Lose weight if overweight. Losing just 10 pounds can make a difference.
• Increase physical activity to 30 to 60 minutes a day.
• Limit alcohol consumption to no more than one alcoholic beverage a day.
If adopting a healthy lifestyle isn’t enough to bring your blood pressure under control, you may need to take a blood pressure-lowering medication. The general goal of treatment when medicine is used is to bring down your blood pressure to less than 140/90 mmHg. For those with diabetes or kidney disease, the goal is less than 130/80 mmHg.
Once you’re taking medication for blood pressure control, see your doctor on a regular basis to review your treatment program. Taking your own blood pressure at home can also help. Maintaining your goal blood pressure should be a top health priority.
The DASH eating plan calls for 4-5 servings a day each of fruits and vegetables (a serving would be a medium apple or 1/2 cup of cooked vegetables), 2-3 servings of low-fat dairy foods (such as 8 oz of 1 percent milk), and 7-8 servings of whole grains a day (one serving is a single slice of whole wheat bread or 1/2 cup of pasta). Bonus: The lower the fat content, the more calcium they contain. Limit meat, poultry, and fish to two or fewer servings (and choose leaner cuts of meat and fish rich in healthful omega-3 fats, such as salmon).
The number of servings is determined by calorie-intake ranges that depend on your weight and how active you are. For example, a moderately active woman who weighs 140 pounds would need just over 2,000 calories a day (see chart for food servings). If you need to lose weight, you would move to the lower 1,400-1,800 calorie range.
"If you reduce your intake by around 500 calories a day, that’s a good strategy for losing a pound a week. All you need to do is adjust the number of servings in each food group," explains DASH researcher Laura Svetkey, M.D., director of the Hypertension Center at Duke University in Durham, North Carolina.
While some diets have you cut back or eliminate specific foods, the DASH plan does not. "It’s the overall eating pattern you want to maintain, but at a lower level of calories. We can’t say whether the fruits are more important than the grains, or the dairy is more important than the vegetables. We tested the basic eating pattern. We do know that it lowers blood pressure, and therefore we recommend it," says Dr. Sevtkey.
You get more salt-sensitive as you age, so aim for less than 2,400 mg of dietary sodium a day (about a teaspoonful). Even if you don’t add extra salt to food, many processed food products (and even frozen vegetables) contain sodium. So read labels carefully for sodium content. Limit alcoholic beverages to one or fewer drinks a day.
Why does the DASH diet lower blood pressure so effectively? One recent study suggests it may act as a natural diuretic. Writing in the journal, Circulation, Japanese and US researchers say the diets’ high mineral content can help the body get rid of excess salt – just as diuretic drugs do. (Under the new guidelines, diuretics are the first line of therapy for most people with high blood pressure.)
Another randomized trial, published in Lancet, the British medical journal, found that people who ate more fruits and vegetables increased their blood antioxidant levels and lowered their blood pressure. Studies have shown the DASH diet can also lower cholesterol and enhance the effectiveness of some blood pressure drugs.
"This is also a diet high in calcium, which can help prevent osteoporosis. So if you want to eat healthy, this is a good way to do it," concludes Dr. Svetkey.
For more information on the DASH diet, log on to www.nhibi.nih.gov/health/public/heart/hbp/dash.
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