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New Blood Pressure Guidelines: Mayo Clinic Radio

welcome back to Mayo Clinic radio I'm

dr. Tom shives

and I'm Traci McCray last month the

American College of Cardiology and the

American Heart Association announced new

blood pressure guidelines again and that

will significantly increase the number

of Americans who according to the new

numbers have blood pressure that's too

high the committee that drafted the new

guidelines substantially lowered the

blood pressure range of what is now

considered normal that means that people

whose blood pressure used to be

considered prehypertension or high

normal will now be considered elevated

blood pressure or stage 1 hypertension

this change will affect more than 30

million Americans so why the new

guidelines and what does it mean

here to discuss the new guidelines as

Mayo Clinic nephrologist dr. Sandra

Taylor dr. Taylor is also a member of

the writing committee that drafted the

new guidelines welcome to the program

dr. Taylor it's nice to meet you thank

you it's nice to be here so you change

the finish line or the low bar or the

high bar however you want to put it and

it kind of changes the race a little bit

yeah it's not a race and I think there's

solid evidence to support lower levels

for blood pressure goals for people who

have normal blood pressure and people

who have elevated blood pressure so

you've pretty much changed the whole

definition of what is high blood

pressure yes this is a big deal this

guideline it's the first guideline in 14

years on a national level that has

endorsement from multiple different

professional organizations that are

expert include experts in high blood

pressure so it's a big deal and it's

almost you could say overdue you were

you're kind of on the hot seat though

aren't you I mean you were on the

committee that wrote the new guidelines

and has there been some pushback has

there been some controversy about the

new guidelines well I think it's early

the the comments that I hear from people

around me are

I better watch my blood pressure a

little more maybe you know this is

something important that I need to pay

attention to I've had patients that I

see push back a little bit when I say

that a normal blood pressure is you know

less than 120 and that if they have

blood pressure above 130 that is

appropriate to be treated so I think

that patients the public will need to

understand what this is about and it may

take a little time to get used to well

it also just gets it on people's radar

about blood pressure it's a good

conversation to have so what exactly or

what causes high blood pressure yeah

first of all I don't think we totally

know high blood pressure is more likely

as you age and it occurs with age in

societies that eat a high salt diet so

presumably there's some relationship

between sodium or salt intake and

stiffening blood vessels that causes

high blood pressure it tends to run in

families but even if you don't have it

in your family if you live long enough

you're likely to develop high blood

pressures so you could almost consider

it a rite of passage something that is

very common with age it's a little bit

hard to understand that there are so now

they're not that many of us who are

actually spared the diagnosis of having

high blood pressure I mean the new

statistics show that under that the new

guidelines more than a hundred million

people that's more than forty five

percent of American adults have high

blood pressure right and if you're gonna

be well actually if you look at adults

over 65 you'd probably it would be about

ninety percent so it has to do with age

so I in 20 year olds it's not very

common in 30 a little more forties

fifties etc so that overall 45 percent

is really skewed toward older age

individuals just like it took us a long

long time to figure out that smoking not

only caused lung cancer but also caused

cardiovascular disease has it taken us a

long time to figure out that there was

such a strong relationship between high

blood pressure and kidney disease heart

disease stroke etc I mean these

guidelines have come down and down and

down over the years right they started

back in the 1960s 1970s but there were

there were trials even back then the VA

cooperative study is a famous landmark

study it was one of the first studies

where they treated people with high

blood pressure and started to prevent

cardiovascular disease now at that time

it was based on diastolic blood pressure

the lower blood pressure number and

these were men with very high blood

pressure who were treated and the

results were dramatic the number of

people who had you know even fatal

events was markedly reduced with blood

pressure treatment which one of those

numbers is the more important one the

upper one or the lower one or explain

what those means yeah that's a very good

question so systolic blood pressure is

the blood pressure when the heart beats

that's the upper number when you get a

reading diastolic blood pressure is the

pressure between beats when the heart

rests so and that's the lower number

initially it was thought that diastolic

blood pressure was the most important

one when the heart is rustic yeah when

your heart is resting and the early

studies and all of the recommendations

were based on the diastolic blood

pressure but over the years we found

that actually cystic but pressure the

upper number correlates with risk risk

for heart disease risk for stroke risk

for kidney disease much more so and so

now for many years but but more so in

recent years the focus has been on

systolic the upper number so tell us

about the the the new guidelines and how

you're going to help patients get their

blood pressure lower will require a lot

more people to beyond

a blood pressure medication or are you

gonna advocate more for lifestyle change

so it may sound a little complicated

I'll try to explain this very simply so

Tracy you talked about that normal is

less than 120 systolic in less than 80

diastolic this elevated range is 120 to

129 systolic and so in that range we

would just tell people to you know keep

an eye on it and and limit their saw try

to keep their weight down sort of

lifestyle practices but it's it doesn't

require treatment the the big change is

when you get to a systolic pressure of

130 to 139 or a diastolic pressure of 80

to 89 now that's gonna be called stage 1

hypertension and in that situation

everybody would be advised to follow to

change lifestyle practices to follow

lifestyle modifications that would lower

your overall cardiovascular risk and

lower your risk or lower your blood

pressure actually for a subgroup of

those people if they have already have

heart disease already have had a stroke

or heart failure if they're diabetic if

they have kidney disease those

individuals we would start on medication

as well as lifestyle practices at 130 or

higher so that's a change what are the

lifestyle changes that people can make

starting right now right so I'll give

you a list and all of these are good

options so first of all is weight loss

get your weight down to a normal body

weight maybe not just under obese would

be a good starting goal second limit

your salt intake that would be sodium we

need to read the labels to do that third

regular exercise aerobic or resistance

training 90 to 150 minutes a week

fourth limit alcohol

moderation so no more than two drinks a

day for men one drink a day for women

and I suppose it goes without saying no

smoking no smoking

all right you have certainly emphasized

the fact that high blood pressure is

extremely important and the other

important thing we ought to tell our

listeners is you got to go in and get it

checked because you can't tell what it

is it's an asymptomatic condition they

used to call it the silent killer maybe

they still do still do thanks so much

for updating us on the guidelines dr.

Sandra Taylor nephrologist at the Mayo

Clinic kidney specialist thanks for

being here thank you