Updated Guidelines to Reduce High Blood Pressure Released

Elevated blood pressure is no joke. According to the CDC, only 25% of those with hypertension have it under control. New guidelines advise more aggressive care.

The American College of Cardiology, in collaboration with the American Heart Association, has recently released new guidelines to reduce high blood pressure. Guidelines haven’t been updated since 2017.

In addition to focusing on foods that are part of the DASH diet, including fruits, vegetables, whole grains, legumes, nuts, seeds, and non-fat and low-fat dairy products, the new guidelines also advise Americans to limit the quantity of alcohol they consume. Lean meats, fish, poultry, and non-tropical oils are also appropriate.

While giving up alcohol completely is preferable, the two medical organizations continue to encourage two or fewer drinks daily for men and one or fewer drinks for women per day.

Regular physical activity is also recommended. Experts advise a minimum of 75 to 150 minutes of exercise weekly, from cardio to weight training.

Heart disease continues to kill

According to the report, heart disease remains the leading cause of death in the US and globally despite the many ways to prevent hypertension and sustain a healthy blood pressure.

Newer research finds that blood pressure also impacts brain health, including cognitive decline and dementia. Small blood vessels in the brain may be damaged, which are linked with memory problems and progressive cognitive decline.

The new guideline suggests early treatment is advised for individuals with hypertension with a goal of below 130 mm Hg for adults with high blood pressure to prevent cognitive impairment and dementia.

Normal blood pressure is still considered to be 120 or under (systolic) and 80 or under (diastolic). Individuals with systolic blood pressure between 120 and 129

Over 46% of adults in the US have higher-than-normal blood pressure, which is known as stage 1 or stage 2 hypertension.

Individuals with a systolic blood pressure between 130 and 139 mmHg or a diastolic blood pressure between 80 and 89 mmHg are considered to have stage 1 hypertension. Elevated blood pressure is 120-129/80 mm Hg.

Those with stage 2 hypertension are dealing with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher.

Meanwhile, stage 2 hypertension refers to those with a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher.

Updated guidance on medications, including the early management for high blood pressure to reduce the risk of cognitive decline and dementia; use of specific medicines, such as the possible addition of newer therapies like GLP-1 medications for some patients with high blood pressure and overweight or obesity, and recommendations for managing high blood pressure before, during, and after pregnancy

Specific blood pressure-related guidance includes:

• Limiting sodium intake to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day by checking food labels. Most sodium intake comes from packaged foods, not using table salt

• Ideally avoid alcohol completely. For those who continue to drink, two or fewer drinks daily for men and one or fewer drinks per day for women.

• Controlling stress through exercise in addition to including stress-reduction techniques such as breathing control, meditation, or yoga.

• Maintaining or reaching a healthy weight, with a goal of at least a 5% reduction in body weight in adults who with overweight, or obesity;

• Adhering to a heart-healthy eating pattern, such as the DASH eating plan, which focuses on less sodium intake and a diet high in vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat or nonfat dairy, and includes lean meats and poultry, fish and non-tropical oils.

• Increasing physical activity to at least 75-150 minutes each week including aerobic exercise (such as cardio) and/or resistance training (such as weight training); and

• Using a home blood pressure monitor is recommended for patients to help confirm the office diagnosis of high blood pressure and to monitor, track progress, and personalize care as part of an integrated care plan.  

Additional factors included in the new guidelines that impact a person’s blood pressure include:

• Behavioral, environmental, hormonal, and genetic influences, including tobacco use.

• Quality of diet

• Dietary factors such as sodium intake (less is recommended), potassium intake (more is advised), and alcohol consumption (little to none is recommended)

• Intake of calcium, fiber, magnesium, and plant-based protein

• Weight and related metabolic issues

• Age, obesity, and insulin resistance

• Sleep disruption and psychosocial stress

• Fitness and physical activity

• Chemical toxins, and environmental exposures including air pollution and heavy metals

The full report and guidelines may be accessed here: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000249

Lisa Andrews, MEd, RD, LD