If barely hypertension does not reply to life-style change, remedy may help

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Healthcare professionals should consider prescribing medication for patients with mildly elevated blood pressure if levels do not decrease after six months of healthy lifestyle changes, according to new scientific opinion from the American Heart Association. The statement, published today in the association's journal Hypertension, fills a void in policy recommendations by addressing untreated Stage 1 (130-139 / 80-89 mm Hg) hypertension, which was not fully addressed in 2017 Treatment guidelines.

The American College of Cardiology / American Heart Association's 2017 Blood Pressure Management Recommendation for Patients with Stage 1 Hypertension and Low Blood Pressure (Changes to healthy lifestyle and subsequent repetition of blood pressure monitoring in six months. For Patients with Stage 1 hypertension and high blood pressure)> 10%) 10-year risk of heart attack or stroke. The guidelines recommend antihypertensive medication in addition to a healthy lifestyle.

Today's scientific opinion suggests that physicians should consider medication for patients with a low 10-year risk when striving for blood pressure (high blood pressure) goals.

"There are no treatment recommendations in the current guidelines for patients with a relatively low short-term risk of heart disease if blood pressure does not drop below 130 mm Hg after six months of recommended lifestyle changes," said Dr. Daniel W. Jones. FAHA, Chair of the Statement Writing Group, Professor and Dean Emeritus of the University of Mississippi Medical School in Jackson, Mississippi, and past President of the American Heart Association. "This statement fills that gap."

Many people with stage 1 high blood pressure are adults under 40 years of age. There are no randomized controlled studies examining these patients' risk of cardiovascular disease. Therefore, the statement-making committee relied on other evidence, including observational studies, that focused on the relationship between these patients' blood pressure and cardiovascular disease.

"We know that people with blood pressure less than 130/80 mm Hg have fewer markers of cardiovascular risk, such as increased coronary calcium, enlarged heart, or build-up of fatty deposits called atherosclerosis in the neck arteries. There is strong evidence of this treatment for high blood pressure saving lives by reducing the risk of heart attacks and strokes, "Jones said.

Healthy lifestyle changes to lower blood pressure include achieving ideal body weight, exercising (30 minutes on most days of moderate to vigorous physical activity, if possible), limiting dietary sodium levels, improving potassium intake, and following DASH guidelines. Diet (Dietary Approaches to Stop Hypertension) (combination diet of fruits and vegetables with low-fat dairy products and reduced saturated fat and total fat). In addition, patients should be advised to limit alcohol and not smoke. These remain the cornerstone of cardiovascular disease prevention.

"If blood measurements don't improve after six months with lifestyle changes, doctors should consider adding medications to control blood pressure," Jones said. "This is an important message that patients should hear too, as they should have their blood pressure checked regularly to monitor progress. If they don't achieve a mean daily systolic blood pressure less than 130 mm Hg, it is probably time to get one Start talking to her doctor about practical next steps, including adding medication to control her blood pressure. "

For people who took antihypertensive drugs as adolescents, there is evidence that, without intervention, they are likely to develop markers of cardiovascular disease in young adulthood. The statement suggests that the original indication to begin treatment, usually to ward off organ damage from long-term high blood pressure, should be considered when assessing the need to continue medication.

The draftspersons recognize that it is difficult to achieve and maintain lifestyle change goals over time. "In America and most of the developed world, it is very difficult to limit sodium enough to lower blood pressure," said Jones, "and it is difficult for all of us to maintain a healthy weight in what I describe as a toxic food environment. Us . " We want doctors to advise patients to take healthy lifestyle changes seriously and to do their best. We certainly prefer to meet blood pressure goals without additional medication. However, successful treatment for high blood pressure extends both years and quality of life. "

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More information:
Daniel W. Jones et al., Management of Stage 1 Hypertension in Adults at Low 10-Year Risk for Cardiovascular Disease: Bridging the Gap: A Scientific Opinion from the American Heart Association, Hypertension (2021). DOI: 10.1161 / HYP.0000000000000195

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American Heart Association

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