No Stroke of Luck: Why New Hypertension Guidelines will Save Hearts & Minds


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New hypertension guidelines out this week now define high blood pressure (BP) as a systolic (top number) of at least 130 mm Hg or diastolic (bottom number) of at least 80.  These levels have come down from the “140/90” definition of hypertension established two decades ago.  Prior to that time…when I was a medical student, much less emphasis was placed on systolic BP.  In fact, physicians would simply take your age, tack on the number “100” and determine whether your systolic BP exceeded your age…if not, no worries.  But over the years, we’ve come to realize that living with a BP of 140/90 DOUBLES your risk of stroke or heart attack death and levels of 160 (systolic) or 100 (diastolic) QUADRUPLES risk!  Fortunately, it’s no stroke of luck that lowering systolic BP to 120 mmHg saves hearts and minds!

If you are told that your blood pressure is high at your physician’s office, you should check it at home using a digital monitor.  I suggest finding a quiet room, sit for a few minutes and obtain an initial BP reading. If elevated (as is often the case), discard the first reading and then take the average of a 2nd and 3rd BP reading spaced 3-5 minutes apart. Repeat this process at approximately the same time each night for 1 week to get a reasonably accurate assessment of your BP readings at home.

If your blood pressure is 130/80 or higher at home, I suggest the following to bring it down to a normal level (less than 120/80):

  • Weight loss: 5-10% of body weight loss can lower BP ~5-10 mmHg.
  • Try the DASH diet (aiming for less than 1500 mg of sodium or ¾ of a teaspoon of salt daily). A DASH diet can lower BP ~7-12 mmHg, and may be independent of weight loss.
  • *Increase potassium intake by ~3500 mg daily. The amount of potassium in top food sources is illustrated on page 42 of “Heal Your Heart”). Increasing potassium by ~3500 mg per day can lower BP ~8-12 mmHg.
  • Moderate activity such as brisk walking (3-4 miles/hr) for 30 minutes at least 5 days a week can reduce BP another ~5-10 mmHg.

*discuss further with your doctor if you have kidney problems

Dr. Michael Miller is a cardiologist and Professor of Medicine at the University of Maryland School of Medicine.  He is also a member of the American Heart Association (AHA) Nutrition Council and his latest book is “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” – 100% of book proceeds are donated to the AHA.

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