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A Better Way To Make High Blood Pressure Treatment Decisions

New research suggests that when deciding whether to start medication for high blood pressure, it's important to consider not just the short-term, but also the long-term risk of developing cardiovascular disease (CVD).

This study, published in Hypertension, compares two tools used to calculate these risks: the American Heart Association's PREVENT calculator and the Pooled Cohort Equations (PCE).

"Many people may not have a heart attack or stroke, or develop heart failure in the next few years, yet they may benefit from lowering their blood pressure to protect them against these conditions later in life," said Paul Muntner, Ph.D., the study's lead author and a visiting professor at the University of Alabama at Birmingham.

He suggests that experts should consider both near-term and lifetime risks for heart disease when making treatment recommendations.

The study compared the predicted risks using PREVENT, released in 2023, and the older PCE tool. PREVENT stands for Predicting Risk of Cardiovascular Events and uses sex-specific equations.

It includes markers of kidney disease and blood sugar levels, and it estimates both 10-year and 30-year risks for heart attack, stroke, and heart failure. It also considers additional risk factors, such as social and economic conditions.

In contrast, the PCE tool only calculates a 10-year risk and does not include heart failure or other risk factors like kidney function or statin use.

It was designed to assess the 10-year risk of heart attack and stroke for individuals aged 40 to 79, while PREVENT can assess CVD risk in individuals aged 30 to 79 and predict both 10-year and 30-year risks.

According to the 2017 ACC/AHA Guideline for managing high blood pressure in adults, a 10-year risk of heart attack or stroke of 10% or greater, as estimated by the PCEs, is considered high risk and should prompt discussions about blood pressure-lowering medications.

For this study, a 10-year risk of 15% or higher, estimated by PREVENT, was considered high risk.

Researchers analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) from 2013 to 2020, including 1,703 adults aged 30 to 79 with stage 1 hypertension.

They compared the participants' predicted risks of CVD using both tools and found some notable differences.

The average 10-year risk for heart attack and stroke was 2.9% using PREVENT, compared to 5.4% using the PCE tool. This means that if the same risk thresholds were used, some people might not be advised to start medication based on the PREVENT prediction.

However, the study found that many of these people had a high 30-year risk, which could be crucial information for deciding on treatment.

"Many people with stage 1 high blood pressure who are not likely to have a heart attack, stroke, or heart failure within the next 10 years may have a high risk over the next 30 years," Muntner explained.

"People may want to discuss this with their doctors and consider starting antihypertensive medication to lower their blood pressure to reduce their long-term risk."

The study participants had an average age of 49.6 years, with 55% identifying as men and 45% as women. The group was diverse, with 65.8% identifying as white, 15.5% as Hispanic, 10.1% as Black, 5.8% as Asian, and 2.7% as other races or ethnicities.

Additionally, 17.2% of participants smoked, 9.6% were taking statin medications, 8.4% had diabetes, and 9.1% had chronic kidney disease.

Blood pressure was measured during a single visit, and participants answered questions about their health and medical history. Those with a prior diagnosis of coronary disease, heart attack, stroke, or heart failure were excluded from the analysis.

"Cardiovascular prevention is important for people of all races and ethnic groups. Non-Hispanic Black adults have a higher risk of stroke and heart failure compared with other groups," Muntner noted. "Ensuring equal access to treatments that lower blood pressure is crucial for all adults."

The study had some limitations, such as using blood pressure measurements from a single visit and combining data from multiple years to ensure a large enough sample size.

Despite these limitations, the findings highlight the importance of considering both short- and long-term risks when treating high blood pressure.

Sadiya S. Khan, M.D., who was not involved in the study, emphasized the significance of the findings.

"This study highlights that the burden of stage 1 hypertension is high, and our goals should be to keep blood pressure as optimal as possible for as long as possible," she said. "This can be achieved through lifestyle changes and, when necessary, medication."

The results underscore the value of using accurate and precise risk models to guide treatment decisions and improve health outcomes for individuals with high blood pressure.

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The research findings can be found in Hypertension.

Understanding The Cause Of White Coat High Blood Pressure

White coat hypertension is a condition where a person's blood pressure readings are higher when taken in a medical setting, such as a doctor's office, compared to readings taken at home or in other non-medical environments.

This phenomenon can be puzzling and sometimes misleading, as it might suggest that a person has high blood pressure when they actually don't.

Let's explore the causes of white coat hypertension and how it can be treated, using simple language.

The term "white coat hypertension" comes from the white coats traditionally worn by doctors. The condition is thought to be caused by the anxiety or nervousness some people feel during medical appointments.

This anxiety can cause a temporary increase in blood pressure, leading to readings that are higher than usual. It's estimated that about 20-30% of people who have high blood pressure readings in a medical setting actually have normal blood pressure in other settings.

Research shows that the sympathetic nervous system plays a key role in white coat hypertension. When a person feels anxious or stressed, their body releases stress hormones like adrenaline.

These hormones cause the heart to beat faster and the blood vessels to constrict, which raises blood pressure. This response is part of the "fight or flight" mechanism that prepares the body to deal with perceived threats, including stressful situations like a visit to the doctor.

While white coat hypertension itself might not be as dangerous as sustained high blood pressure, it's still important to address because it can be a sign of an underlying condition called masked hypertension.

Masked hypertension is when blood pressure is normal in a medical setting but high in everyday life, which can increase the risk of cardiovascular problems if left untreated.

Treating white coat hypertension involves a combination of accurate diagnosis and strategies to manage anxiety. The first step is to ensure that the elevated blood pressure readings are not due to a chronic high blood pressure condition.

This typically involves monitoring blood pressure at home over a period of time using a reliable home blood pressure monitor. Keeping a record of these readings and sharing them with your healthcare provider can help distinguish between white coat hypertension and true hypertension.

Ambulatory blood pressure monitoring (ABPM) is another method used to diagnose white coat hypertension. ABPM involves wearing a portable device that measures blood pressure at regular intervals over 24 hours, including during sleep.

This provides a comprehensive picture of blood pressure variations throughout the day and night, helping to confirm whether high readings are limited to the medical setting.

Once white coat hypertension is confirmed, addressing the anxiety that causes it is crucial. Relaxation techniques such as deep breathing exercises, meditation, and mindfulness can help reduce anxiety levels before and during medical appointments. Practicing these techniques regularly can help make them more effective in stressful situations.

Another approach is cognitive-behavioral therapy (CBT), a type of therapy that helps people change negative thought patterns and behaviors associated with anxiety. CBT can be particularly useful for individuals who experience significant anxiety during medical visits.

Lifestyle changes can also help manage white coat hypertension. Regular physical activity, a healthy diet, and adequate sleep can all contribute to lower overall anxiety and improved heart health. Reducing caffeine and alcohol intake, which can increase anxiety and blood pressure, might also be beneficial.

For some people, medication may be necessary to manage both blood pressure and anxiety. If lifestyle changes and anxiety management techniques are not sufficient, healthcare providers might prescribe antihypertensive medications or anti-anxiety medications to help control blood pressure and anxiety levels.

In summary, white coat hypertension is a condition where anxiety in medical settings causes temporary increases in blood pressure. It's important to accurately diagnose this condition to ensure it's not masking chronic high blood pressure.

Treatment involves a combination of monitoring blood pressure at home, using relaxation techniques, cognitive-behavioral therapy, lifestyle changes, and, in some cases, medication.

By addressing the anxiety that leads to white coat hypertension, individuals can achieve more accurate blood pressure readings and better overall health.

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How To Treat Low Blood Pressure Naturally Through Eating Right, Hydration And More

Raise your awareness of how to treat low blood pressure naturally with these at-home solutions.

Eat Right

Adding foods with vitamin B-12 (eggs, chicken and tuna) and rich in folate (broccoli and leafy greens) can stave off anemia, which lowers blood pressure. But reducing your meal size is also key, say the doctors at N.Y.'s Manhattan Cardiology. "When you eat a large meal, it takes your body a lot more energy to digest it, which can send your blood pressure plunging. Having smaller meals throughout the day is healthier for both your digestion and blood flow."

Drink Up

According to the Cleveland Clinic: "When you're dehydrated, it means that your body's water supply is depleted. That loss of fluid is felt everywhere in your body — including blood volume. Low blood volume leads to low blood pressure, meaning your organs may not get the oxygen needed to function properly." Aim for roughly eight glasses of water a day.

Be Salty

"Experts usually recommend limiting table salt and foods high in sodium. That's because salt and sodium can raise blood pressure," explain the folks at the Mayo Clinic. "For people with low blood pressure, though, that can be a good thing." But it's important to always check with your healthcare professional first.

Ease Into It

When moving from lying down to standing, the experts at Johns Hopkins Medicine recommend taking it slow. "Instead of jumping out of bed in the morning, slowly sit up on the edge before standing. Wiggle your feet and move your legs. This will get your heart rate up and increase circulation."

Get Support

Per the U.K.'s National Health Service, try wearing "support stockings" – sometimes called compression stockings. These are tight-fitting elastic socks or tights. They provide extra pressure to your feet, legs and abdomen, which will help stimulate your circulation and increase your blood pressure.

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