Cardiologists and primary care physicians won’t argue that high blood pressure increases your risk of heart disease and stroke. But you may find they’ll now discuss your blood pressure numbers a bit differently with you.
That’s because new blood pressure guidelines that lower the thresholds for high blood pressure were adopted by the American College of Cardiology (ACC) and the American Heart Association (AHA) in late 2017. However, those guidelines have yet to be recommended by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).
A difference in opinions
“Our blood pressure readings will be evaluated a bit differently than cardiologists’, but that’s because we are usually working with a different population,” said Dr. Guy Van der Werf, a family medicine physician at UCHealth Primary Care Clinic – Estes Park. “A less-active person may prompt me to take a more proactive approach to their blood pressure, but a less aggressive approach is necessary when a patient doesn’t have those (cardiac) risk factors.”
Physician guidelines, which were updated by ACP and AAFP in January 2017, recommend:
- People 60 and older keep a less than 150/80 mm Hg blood pressure reading — and less than 140/80 for those under the age of 60 — in order to reduce their risk of stroke or cardiac events.
- For those with cardiac risks (such as a history of stroke, heart disease, diabetes or obesity) and are 60 or over, that number should be 140/80 or less.
However, the new guidelines followed by cardiologists reclassify high blood pressure, setting lower thresholds:
- Normal: Less than 120/80 mm Hg;
- Elevated: Systolic between 120-129 anddiastolic less than 80;
- Stage 1: Systolic between 130-139 ordiastolic between 80-89;
- Stage 2: Systolic at least 140 ordiastolic at least 90;
- Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
“The guidelines are telling us to push lifestyle changes harder at an earlier stage to prevent these cardiac events,” said UCHealth Cardiologist Dr. Chad Stoltz, who sees patients in northern Colorado, including Estes Park.
Do I have high blood pressure or not?
If you’ve been diagnosed with high blood pressure already, you still meet that criteria whether you are being cared for by a cardiologist or your primary care doctor.
But now your cardiologist will put you in a higher stage that may involve a more aggressive approach to lowering your levels, Stoltz said. For example, someone whose blood pressure was in the 120 range would have been classified as having “prehypertension.” That category has gone away and now they would have “elevated” blood pressure and their cardiologist would help put a plan in place to lower their levels. But that doesn’t mean medication, Stoltz added.
According to the ACC and AHA, the guideline changes were based on recent studies that showed that those who are at high risk — such as smokers, overweight individuals, or those with a family history of heart disease or who have diabetes — can benefit greatly by lowering their blood pressure. And this can be accomplished through nonpharmacological interventions, such as reducing sodium intake or increasing exercise.
“We don’t want to throw medication at them right away,” Stoltz said. “It’s really impressive how much you can drop your blood pressure with proactive roles. Losing 10 pounds can make a whole lot of difference. A lot of times it’s simple things.”
Let’s take your blood pressure
But no matter the number at which they classify their patients, both Stoltz and Van der Werf agree that getting an accurate blood pressure reading is the first step.
It is common for physicians to see what they call “white-coat hypertension” from their patients.
“Maybe they are running late to the doctor’s, or the doctor is running late — whatever the reason, factors have caused the patient to showcase high blood pressure during their office visit,” Stoltz said.
Physicians don’t want to treat people for high blood pressure if in fact it’s only the visit to the doctor’s office that has caused it, he said. So, to verify if the patient has high blood pressure, they may suggest the patient take their blood pressure outside the office at different times of the day.
Wal-Mart and other stores, such as Safeway, usually have blood pressure machines located within their pharmacies that anyone can use. (Rocky Mountain Pharmacy in Estes also has this option.) But the most accurate readings come from an at-home blood pressure devices. The new AHA/ACC guidelines stress the use of these home devices.
“These home blood pressure kits are fairly cheap and are very good,” Stoltz said. “We are recommending them because we need to know what a patient’s levels are the rest of the time, and many times we are surprised that their numbers are actually good when they are home. Those patients don’t need to be treated (for high blood pressure).”
And for those with high blood pressure, the at-home kits also have their benefits, he said.
“It’s not uncommon that patients don’t see their doctor for six to 12 months, so it doesn’t hurt for them to be watching their levels and adjusting their lifestyle changes accordingly,” Stoltz said. “We also recommend they keep a blood pressure log so they can share those numbers when they do visit with us, and we can help them adjust their plan accordingly.”