HYPERTENSION: IMPORTANT THINGS FOR ALL TO KNOW

HYPERTENSION is an EPIDEMIC. I will later introduce you to the prevalence rates below. Let us first note that Hypertension ( referred to as HTN from here on) is a major contributor to death.

HTN may raise your risk for heart disease and stroke, which are leading causes of death in the United States. ( source 1).
TAKE HOME POINT IS THAT HYPERTENSION WHEN UNTREATED IS DEADLY.
HTN leads to damage over time and thus it needs to be recognized early on, so it may be treated. As early on no symptoms may be apparent in some patients, there is a need for screening.

The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment. ( source 2)
USPSTF is an independent task force and one of the most respected in its field.
TAKE HOME POINT IS TO START GETTING TESTED AT THE AGE OF 18.

EPIDEMIOLOGY
In the USA, 1 in 3 adults has HTN, This turns out to be about 75 million people. ( source 3). Now you see why it is considered an Epidemic.
There are genetic causes, some structural causes etc which I find beyond the scope of this mostly public awareness post. I am happy to respond to specific questions in the comment section.

DEFINITION
This is the part where you should pay special attention as HTN is now defined in categories that many may not be aware of.
DBP = diastolic blood pressure; SBP = systolic blood pressure.
Stage 2 HTN: SBP ≥160 or DBP ≥100
Stage 1 HTN: SBP 140-159 or DBP 90-99
Category: Blood Pressure, mm Hg
Prehypertension: SBP 120-139 or DBP 80-89
( source 4)
WHY PREHYPERTENSION??
Well prehypertension is not a disease. It simply identifies individuals at risk of developing full blown HTN. at this stage continuing screening and life style modifications become important to prevent or delay the onset of disease.
( source 5)
TAKE HOME POINT: below 120/80 YOU ARE DOING WELL. At 140/90 YOU HAVE HTN. IN BETWEEN YOU ARE AT RISK.
Also note that one reading of high numbers is not HTN. You have to have multiple such elevated readings to have the disease.

WHEN TO CONSIDER TREATMENT
Well the question of where to start treatment has become controversial. In 2012 a Cochrane review said the following:

Benefits of antihypertensive drugs for mild hypertension are unclear ( source 6)
This is where the science currently stands. We know that there are clear benefits of lowering BP in most cases below 140/90.
Even small drops in pressure are important. Very important.
A drop in systolic blood pressure of 3 mm Hg can decrease stroke mortality by 8% and coronary artery disease by 5%.( source 7).
There is emerging evidence that treating even mild HTN, i.e, stage 1 HTN may be of benefit. (Source 8). Whether is changes the guidelines is not of concern for this post.Further discussion is complex and will take away from the heart of this post.
There are risk factors such as age and diabetes etc that your doctor has to take into account to set a target BP goal.
JNC 8 offers guidelines for the following groups.
The 2014 guideline offers recommendations for the management of hypertension in:

People older or younger than age 60 years
People aged ≥18 years with chronic kidney disease
People aged ≥18 years with diabetes
Black and nonblack populations

AMERICAN DIABETES ASSOCIATION AND AMERICAN COLLEGE OF CARDIOLOGY MAY OFFER A DIFFERENT GUIDELINE ESPECIALLY IN DIABETICS OR CHRONIC KIDNEY DISEASE AND MAY RECOMMEND LOWERING PRESSURE TO 130/80 OR LOWER. THIS POST WANTS TO STAY AWAY FROM CONTROVERSIES. STICK WITH JNC 8. No references here to avoid controversy.

TAKE HOME POINT: IF YOUR BP IS CONSISTENTLY OVER 140/90 MUST SEE YOUR DOCTOR TO ESTABLISH TREATMENT GOALS.

TREATMENT GUIDELINES
The reader should use this as a reference only. Your individual treatment is determined by your doctor.
JNC is a Joint National Committee that publishes guidelines for management of HTN. I will have the charts below but note just one important recommendation.
In the general population, pharmacologic treatment should be initiated when blood pressure is 150/90 mm Hg or higher in adults 60 years and older, or 140/90 mm Hg or higher in adults younger than 60 years.
And this is why I mentioned above that treatment depends on many factors and must be individualized.
Here are the charts of the recommendations.

( source for charts, source 9)
( JNC 8 Source, Source 10)

What I really want to focus on is the lifestyle change section. We can all start here today without even the doctor first telling us to do this.

1. STOP SMOKING
2. MODERATE TO VIGIROUS ACTIVITY , ATLEAST 40 MINS, 3-4 DAYS A WEEK
3. GET YOUR LIPIDS AND GLUCOSE UNDER CONTROL.
4. LIMIT SALT INTAKE
5. DASH DIET.
   SEE CHART BELOW FOR DETAILS.

DASH DIET
Source 11, directly from Wikipedia.
The DASH diet (Dietary approaches to stop hypertension) is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (part of the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services) to prevent and control hypertension.
( the above paragraph is a direct copy from Wikipedia)
This diet focuses on :
1, fruits
2, Vegetables
3, whole grains
4, low fat dairy
5, meat, fish, poultry although limiting red meat
6, limiting sweetened beverages, foods and added fat.

DASH IS CONSIDERED THE BEST DIET OVERALL FOR HEALTHY LIVING. It is no 1diet in the U.S. News & World Report's annual “Best Diets” rankings out of 38 tested. ( source is 2016 US news & world report).
The best source to understand and implement DASH DIET is http://dashdiet.org/default.asp ( source 12).

I wish you all better health awareness and happy long life. HTN is a killer. Get checked and get treatment if needed.

Sources.
1.https://www.cdc.gov/bloodpressure/about.htm
2.https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening
3.https://www.cdc.gov/bloodpressure/statistics_maps.htm

1. https://emedicine.medscape.com/article/2172178-overview
2. https://www.ncbi.nlm.nih.gov/books/NBK9633/
3. http://www.cochrane.org/CD006742/HTN_benefits-of-antihypertensive-drugs-for-mild-hypertension-are-unclear
4. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252.
5. http://www.aafp.org/afp/2015/1201/p1020.html
6. http://www.nmhs.net/documents/27JNC8HTNGuidelinesBookBooklet.pdf
7. https://sites.jamanetwork.com/jnc8/
8. https://en.m.wikipedia.org/wiki/DASH_diet
9. http://dashdiet.org/default.asp

N. Inayet, MD, FCCP