April 4, 2016

Hypertension: Guidelines for Coping

High blood pressure has been named the “silent killer” because there are often no symptoms until significant damage—or even death—occurs.

Peter N. Landless

I am 62 years old and have moderate high blood pressure. Over the past year I have read conflicting reports as to the target blood pressure reading I should be striving toward. What is your advice?

High blood pressure is a common and dangerous condition if not adequately treated. It has been named the “silent killer” because there are often no symptoms until significant damage to the heart, kidneys, and brain—or even death—occurs. Untreated high blood pressure may result in a heart attack or stroke (“brain attack”). Symptoms may be less dramatic, such as unusual shortness of breath with mild exercise. There is no doubt that with adequate treatment of blood pressure, there has been a significant decrease in strokes and other complications. Sadly, however, undiagnosed and untreated hypertension is still common even in developed countries. It is important for one to have blood-pressure screening and to know one’s numbers in order to take the necessary treatment as needed.

Even in the 1960s an increasing level of the systolic blood pressure (or upper reading: e.g., the 120 of 120/80 millimeters of mercury) with age was accepted as normal. In fact, the norm was calculated as age in years plus 60; so for a 60-year old, a systolic blood pressure of 120 + 60, or 180 millimeters, was considered normal. Epidemiological studies in the latter part of the twentieth century, as well as the advent of clinical trial studies, debunked this concept, showing that active treatment of even isolated systolic hypertension in the older patient resulted in less complications of the disease. Landmark clinical studies in the 1990s onward showed that the outcomes for patients with a blood pressure reading of 120/80 or less were better than those who remained above 140/90. This led to a much more aggressive management of high blood pressure, even in older patients.

It was quite surprising when in 2014 the Eighth Joint National Committee panel suggested that it was safe to treat patients over the age of 60 years to a level of below 150/90 millimeters of mercury, and for patients aged 30 through 59 be treated to a level of less than 140/90. In November 2015 a large NIH-based study of more than 9,300 patients was stopped prematurely because it was shown that more intensive treatment of hypertension showed significant benefits, with decreased deaths, strokes, and heart attacks with systolic blood-pressure readings of below 120. The results were so clear that the trial was stopped prematurely, as it would have been unethical to withhold intensive therapy from the comparison group, who were targeting a systolic level of below 140.*

In consultation with your physician, who knows your risk factors for cardiovascular events, it makes sense to aim for a systolic blood pressure of 120. Home blood-pressure readings are helpful, and electronic monitors have become more affordable.

Take the pressure off your heart: measure and record your numbers, and follow up with your physician regularly.

* Report from the panel members of the Eighth Joint National Committee, Journal of the American Medical Association 311, no. 5 (2014): 507-520. doi:10.1001/jama.2013.284427.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department.