February is American Heart Health Month, and it’s easy to see why we dedicate 28 days to the heart.

Considering cardiovascular disease is the leading cause of death in the US and around the world, now seems as good a time as any to dive into the latest information.

We know hypertension is one of the leading causes of death and disability-adjusted life years. We also know helping patients control their blood pressure leads to numerous health benefits, including decreased risk of myocardial infarction, heart failure and stroke.

But what about the brain? We have been hearing for a while that adequate blood pressure control can help prevent cognitive decline and dementia.

At the American Heart Association’s 2018 International Stroke Conference, data from the ACCORD-MIND study showed that controlling and preventing systolic blood pressure (SBP) from increasing has a positive impact on preserving the brain’s white matter, as shown via magnetic resonance imaging (MRI).

In a study published in the Journal of General Internal Medicine, researchers found that adequate hypertensive treatment can lower the risk of dementia in older adults, a benefit that was markedly more noticeable in the African American population.1 The evidence is ever increasing — blood pressure control and management is good for patients.

New high blood pressure guidelines

The American College of Cardiology and the American Heart Association recently released new guidelines on how to approach and manage blood pressure.

A new definition of high blood pressure

What’s different? Normal blood pressure is now less than 120/80 mmHg, whereas before, normal was under 140/90. Patients no longer have “prehypertension.”

Now, patients with a systolic of 120 mmHg or more, and a diastolic of less than 80 mmHg are considered to have “elevated blood pressure.”

Patients with a SBP between 130 and 139 mmHg or a DBP between 80 and 89 mmHg are now categorized as “stage 1 hypertension.”

Patients with a SBP of 140 mmHg or a DBP of 90 mmHg are now “stage 2 hypertension.”

New recommendations on managing blood pressure

The recommendations regarding management have also changed; a patient’s atherosclerosis cardiovascular disease (ASCVD) risk (e.g., cholesterol levels, age, sex, race, history of diabetes, smoking) is as important as their blood pressure number when deciding treatment. The conversation regarding lifelong lifestyle changes to improve one’s life should start when the patient has elevated blood pressure, if not sooner.

Why is this important to you?

Lifestyle changes have shown to decrease systolic blood pressure by 4 to 11 mmHg, clearly a conversation worth having with your patients, especially since the guidelines recommend this changes even after starting pharmacological treatment. Pharmacological treatment is recommended for patients considered stage 2, and for patients considered stage 1 as long as their ASCVD risk is >10%.

We have heard from patients about their dissatisfaction when they think doctors only look at their numbers, how impersonal that feels. By considering their ASCVD to formulate a plan of action, the new guidelines give us an opportunity to provide patients with a personalized plan plus the added benefit of not only a longer life but one of better quality.

References

  1. Murray, M.D., Hendrie, H.C., Lane, K.A., Zheng, M., Ambuehl, R., Li, S., Unverzagt, F.W., Callahan, C.M., & Gao, S. (2018). Antihypertensive medication and dementia risk in older adult African Americans with hypertension: a prospective cohort study. Journal of General Internal Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29330643