Hypertension: What the New Recommendations Mean for You
By: Kelcy Tobey
Hypertension, also known as high blood pressure, is a well-known cardiovascular disease, but is that really all that well known? To the general public, systolic and diastolic blood pressure are arbitrary numbers that place people into different risk categories. It does not become a conscious issue until one is medically diagnosed with hypertension. Let’s review.
Blood pressure (BP) is defined as the pressure exerted on the walls of blood vessels, particularly the arterial walls. This pressure is represented by two numbers, measured in millimeters of mercury (mmHg). Systolic blood pressure is the pressure blood exerts on the arterial wall when the ventricles of the heart contract—this is the “top” number of a blood pressure reading. Diastolic blood pressure is the pressure blood exerts on the arterial walls when the ventricles of the heart relax—this is the “bottom” number of a blood pressure reading. Healthy blood pressure is defined as systolic blood pressure of equal to or less than 120 mmHg and diastolic blood pressure of equal to or less than 80 mmHg. When blood pressure increases, this is usually indicative of the heart having to work harder, due to peripheral resistance, in order to deliver blood to the rest of the body. Peripheral resistance can be a result of arterial stiffness (inflexibility of the arteries to accommodate for the pressure exerted on them) or even plaque buildup within the arteries.
In 2017, the American College of Cardiology and the American Heart Association came out with new blood pressure guidelines (ACC, 2017):
- Normal BP: Less than 120/80 mmHg
- Elevated BP: Systolic BP between 120-129 mmHg and diastolic BP less than 80 mmHg
- Stage 1 Hypertension (HTN): Systolic BP between 130-139 mmHG or diastolic BP between 80-89 mmHg
- Stage 2 HTN: Systolic BP at least 140 mmHg or diastolic BP at least 90 mmHg
- Hypertensive crisis: Systolic BP over 180 mmHg and/or diastolic at least 90 mmHg, with patients needing prompt changes in medication if there are no other indications or problems, or immediate hospitalization if there are signs of organ damage.
Prior to this change, the systolic and diastolic values were different for each stage; additionally, there was a “Prehypertensive” category. Unfortunately, these new numbers place nearly half of the U.S. population as hypertensive (46%). In reference to the previous hypertension guidelines, a greater percentage of the adult population with disabilities (34.2%) have high blood pressure than adults without disabilities (26.9%) (Stevens et al., 2014). This begs the question—how has that percentage changed with the new guidelines? Are more adults with disabilities now considered at risk? If that’s the case, how will this impact one’s health outcomes?
Alas, hypertension is not as simple as it appears. It is a major predictor of various cardiovascular diseases. In fact, hypertension is an independent risk factor for stroke and coronary artery disease. Stroke occurs when there is a blockage of blood flow to or a rupture of an artery in the brain that leads to the sudden death of brain cells. Coronary artery disease is a condition that negatively impacts the health of the arteries that supply the heart. So the next question is, how do we prevent it?
Smoking, physical inactivity, overweight and obesity can all contribute to high blood pressure. The good news is that many of these factors can be changed due to alterations in lifestyle. Cessation of smoking, becoming more active, and losing weight can reduce the risk of/reduce high blood pressure.
Fortunately, physical activity is one of the easiest variables to manage. The American College of Sports Medicine (ACSM) is an excellent source of the level and amount of physical activity Americans should be getting on a regular basis. To combat hypertenstion, there’s no need to join your local CrossFit gym or enlist in group fitness bootcamps. Simply being physically active in any shape and form can improve health. Physical activity can range from strolling the park to high intensity interval training (HIIT). For more sedentary individuals, it is best to start low and work your way up. For example, exercise at a level where it’s difficult to sing; this is called the “Talk Test”. If you can hold a conversation but are unable to sing during your workout than you are exercising at the correct level. Other examples of staying physically active include visiting a coworker in the office rather than sending an email or a text or going for a walking meeting.
Additionally, exercise does not have to be grouped into one long session. One of the main reasons people note that they are physically inactive is due to a lack of time. Intentional physical activity can be broken up into three 10 minute segments over the course of one day. Anything that elevates the heart rate above resting for an extended period of time is of benefit. Consistently engaging in frequent physical activity is of key importance. As stated previously, physical activity does not have to be complicated, nor does it need to be something you hate. Find something you love and you will be more likely to stick with it.