By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S PRE-HYPERTENSION NEEDS TREATMENT TO AVERT COMPLICATIONS

Question: I went to the doctor last week and he said my blood pressure was too high. It was 130/85!! Last year that was a fine blood pressure; now it is too high. Can you give me more information about what my blood pressure should be?

Answer: You are right to be a bit confused about your blood pressure reading. In the past your reading was considered “a little high” but not something that would be treated -- just watched. But new guidelines have come out concerning the management of blood pressure and the level at which a reading is considered to be high blood pressure.

Let me give you an overview of the current recommendations, bearing in mind that these may change again as scientists learn more about how various levels of blood pressure affect our health.

The new guidelines for blood pressure consider a blood pressure to be normal if it is BELOW 120/80 mmHg. Both the systolic (top number) and the diastolic (bottom number) need to be lower than 120 and 80, respectively. There is even a push to consider a normal blood pressure to be 115/75 mmHg. The reasoning behind these new lower levels is that your risk of cardiovascular damage may increase at levels as low as even 120/80.

There is a new classification called “pre-hypertension” for people whose blood pressures are between 120 and 139 systolic and 80 and 89 diastolic. In your case, both of the numbers you report are in this pre-hypertension range. However, according to the guidelines, you are considered pre-hypertensive even if you have only a single number in one of these ranges. Therefore, you are at increased risk for a cardiac event, and you should be treated.

Pre-hypertension is treated in many different ways. Lifestyle modifications, such as a low-salt, low-fat diet and physical exercise, such as brisk walking 30 minutes daily, are great places to start. If you are overweight, losing weight is a must. If you are over 50, your physician may want to start you on blood pressure medications while you are getting up to speed on the lifestyle changes. People who are pre-hypertensive are much more likely to develop hypertension -- persistent blood pressure over 140/90. Keeping the blood pressure lower and having an active lifestyle may prevent or delay the development of hypertension.

You should have your blood pressure checked at least every six months and work with your physician to maximize your lifestyle changes. In the past, physicians used to “watch” your blood pressure until it got into the truly hypertensive range. The recommendation now is to treat blood pressure problems early to prevent complications later.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.