Forget the old safe target for blood pressure - 140 over 90 - because new federal guidelines say that if you want to consider yourself healthy you need to be at 120 over 80. That's a huge cut, but it happened, because a federally funded study called SPRINT showed that there's an abundance of evidence that says it is worthwhile to more aggressively attack high blood pressure.
"This is very important, as there are millions of individuals who would benefit if their blood pressure was lowered to this new goal of 120 - benefit by having fewer strokes, fewer heart attacks and having less likelihood of developing heart failure and kidney dysfunction," said Dr. Richard Wright, cardiologist at Providence Saint John's Health Center in Santa Monica.
The more you lower blood pressure - within reason - the healthier your cardiovascular system is likely to be. According to the American Heart Association, really, blood pressure can't be too low. "Within certain limits, the lower your blood pressure reading is, the better," it says. "There is no specific number at which day-to-day blood pressure is considered too low, as long as no symptoms of trouble are present." If you are not dizzy or lightheaded or falling, your blood pressure is probably fine.
While high blood pressure once was seen as primarily a disease of the elderly, there are ever more cases among the young, especially as obesity grows as a national health problem in all age groups. A scholarly paper by Dr. Margaret Riley and Dr. Brian Bluhm asserted that hypertension - as docs call high blood pressure - is even on the rise among kids. Said the doctors: "The combined prevalence of prehypertension and hypertension in adolescents who are obese is greater than 30% in boys and is 23 to 30% in girls."
Multiple physicians said similar: especially as obesity becomes more common in the U.S. - and one in three adults and one in six children now are said to be obese - the incidence of high blood pressure keeps climbing.
One in three adults - 78 million - have it, according to the American Heart Association. Roughly one in two who have it do not have it under control and that is bad news, because those people are prime candidates for devastating cardiovascular events.
What if this means you? First off, if you are 65 or older, stop fretting.
Internist Dr. John Whyte said that in most cases, for that population, most physicians are sticking with the 140/90 target. He explained: "For patients over 65 we need to be careful. If blood pressure drops too low, people get dizzy and fall - which can cause problems. They can also develop electrolyte problems which can affect their heart."
As for the rest of us, physicians say the first step in treating high blood pressure is to make what they call lifestyle changes, primarily losing weight, exercising regularly (maybe five times week, 30 minutes or more), cutting way back on - or eliminating - alcohol, salt, caffeine. Will that solve your problem? Don't count on it. It was never easy to lower blood pressure with lifestyle changes and with the new, still lower targets, the odds are not good.
"In my experience few people can control their hypertension with lifestyle alone because the psychologists have taught us that only about 20% have enough motivation to actually live that healthier lifestyle," said Jennie Johnson, a cardiac nurse and author of Wake Up Call 911 It's Time to Reduce Your Risk for a Heart Attack and Stroke.
Cardiologist Wright said similar: "For people who have high blood pressure, it is infrequent that lifestyle changes lower the blood pressure to the recommended goal and for the majority of such individuals medications will thus be required."
At what cost? Plenty of high blood pressure meds are available as low cost generics. Commonly prescribed losartan is widely available for under $10 per month. Amlodopine is even cheaper. Lisinopril is $4 per month at Walmart.
Should you take a pill or - as is increasingly common with the lower targets - multiple pills?
"Antihypertensive medications should be taken if a patient has hypertension," said Dr. Carl Horton, a cardiologist with Texas Health Physicians Group. "Yes, all medications can have potential side effects but usually patients can be placed on medications which they can tolerate. Some of the common side effects would be headache, dizziness, erectile dysfunction, bradycardia, constipation or swelling. But patients need to be educated about the long term consequences of untreated hypertension which include end stage renal disease, stroke, congestive heart failure, and increased risk of myocardial infraction [heart attacks]."
That's the calculus. Cheap pills control blood pressure in most patients - and, among those who don't take the pills, they face real, deadly health consequences. For most of us, said the docs, there shouldn't be any choice at all.
This article is commentary by an independent contributor. At the time of publication, the author held TK positions in the stocks mentioned.