Jackson, MS—Even slightly elevated blood pressure should be treated with medication if lifestyle changes don’t resolve the issue in 6 months, according to a new scientific statement from the American Heart Association.

The statement, published in the journal Hypertension, provides more information on how best to manage untreated, stage 1 high blood pressure—levels of 130-139/80-89—mm Hg. The issue was not fully addressed in the 2017 treatment guidelines, according to the authors led by Daniel W. Jones, MD, professor and dean emeritus at the University of Mississippi School of Medicine.

Based on the 2017 American College of Cardiology/American Heart Association Blood Pressure Management Guidelines’ recommendation for patients with stage 1 hypertension and a low (<10%) risk for having a heart attack or stroke within 10 years, clinicians are advised to first treat with healthy lifestyle changes and then repeat the blood pressure check in 6 months. For patients with stage 1 hypertension and a high (>10%) 10-year risk for heart attack or stroke, the guidelines recommend antihypertensive medication in addition to healthy lifestyle.

The new scientific statement suggests clinicians should consider medication for patients with a low 10-year risk if the blood pressure goals of less than 130/80 mm Hg are not met after 6 months of sustained healthy lifestyle changes. The new guidance is expected to apply to nearly 10% of American adults with hypertension.

“There are no treatment recommendations in current guidelines for patients who are at relatively low short-term risk of heart disease when blood pressure does not drop below 130 mm Hg after six months of recommended lifestyle changes," Dr. Jones explained. “This statement fills that gap.”

Many patients with stage 1 high blood pressure are adults under age 40 years, and few, if any, randomized, controlled trials have focused on their cardiovascular disease risk. That meant the statement writing committee had to rely on other forms of evidence, including observational studies focused on the relationship between blood pressure and cardiovascular disease.

“We know that people with blood pressure lower than 130/80 mm Hg have fewer markers of cardiovascular risk like elevated coronary calcium, enlargement of the heart, or buildup of fatty deposits called atherosclerosis in arteries of the neck” Dr. Jones said. “There is strong evidence that treating high blood pressure saves lives by reducing the risks for heart attack and stroke.”

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)
• Smoking cessation
• Limiting alcohol
• Dietary changes including limiting sodium, enhancing potassium intake, and following the Dietary Approaches to Stop Hypertension (DASH) diet (a combination diet of fruits and vegetables with low-fat dairy products and reduced saturated fat and total fat).

The advice is especially important for patients who took blood pressurelowering medication as adolescents, according to the authors, because there is evidence that, without intervention, these individuals are likely to develop markers of cardiovascular disease in young adulthood.

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