Is a Blood Sodium Reading of 147 Bad

The American College of Cardiology and the American Heart Association certainly grabbed the attention of the states busy primary care physicians with the recent release of their updated claret pressure guidelines. These organizations had piqued interest by declaring the release date and labeling it as "highly anticipated." I pooh-poohed all that drama, but upon reading through the 114-page executive summary PDF with 21 authors and almost a thousand references, I have to say, I am duly impressed.

The definition of the diagnosis of high blood pressure and the decision-making procedure surrounding treatment accept traditionally been quite individualized (read: all over the identify). Personally, I invite these stricter measures, because they are accompanied past solid enquiry, logistical guidance, and useful management strategies.

However, a whole heck of a lot of people only got pulled into a significant medical diagnosis.

Let's review what'due south new.

A new definition of high blood force per unit area (hypertension)

(Delight note that all numbers refer to mm Hg, or, millimeters of mercury.) The guidelines, in a nutshell, state that normal blood force per unit area is under 120/80, whereas up until Monday, normal was under 140/90.

Now, elevated claret pressure (without a diagnosis of hypertension) is systolic claret pressure (the top number) between 120 and 129. That used to be a vague category called "prehypertension."

Stage one high claret pressure (a diagnosis of hypertension) is at present between 130 and 139 systolic or between fourscore and 89 diastolic (the bottom number).

Phase 2 loftier blood force per unit area is now over 140 systolic or 90 diastolic.

The measurements must take been obtained from at least two careful readings on at least two different occasions. What does careful mean? The guidelines provide a six-stride tutorial on how, exactly, to correctly measure a blood pressure, which, absolutely, is sorely needed. My patients often take their first blood pressure taken immediately subsequently they have rushed in through downtown traffic, as they're sipping a large caffeinated beverage. While we e'er knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading.

New recommendations on monitoring blood pressure

The new guidelines also encourage additional monitoring, using a wearable digital monitor that continually takes blood pressure readings every bit yous go most your life, or checked with your own cuff at home. This additional monitoring tin help to tease out masked hypertension (when the claret pressure level is normal in our part, but high the rest of the time) or white coat hypertension (when the blood force per unit area is high in our role, but normal the rest of the fourth dimension). There are clear, helpful directions for setting patients upward with a dwelling claret pressure monitor, including a recommendation to give people specific instructions on when not to check blood force per unit area (inside 30 minutes of smoking, drinking coffee, or exercising) and how to take a measurement correctly (seated comfortably, using the correct size cuff). The home blood force per unit area gage should first be validated (checked in the office, for accurateness).

If you lot now have high blood pressure, y'all may not need meds… however

The guidelines also outline very conspicuously when a nutrition-and-lifestyle approach is the recommended, first-line treatment, and when medications are simply only what you accept to do. Thankfully, the decision is largely based on facts and statistics. For the elevated claret pressure category, medications are really not recommended; rather, a long listing of evidence-based, not-drug interventions are. What are these interventions? Things that really work: a diet high in fruits and vegetables (such every bit the DASH diet, which is naturally loftier in potassium); decreased common salt and bad fats; more activity; weight loss if 1 is overweight or obese; and no more than two alcoholic drinks per 24-hour interval for men, and one for women. Simply changing what you consume can bring down systolic blood pressure by as much equally 11 points, and each additional healthy habit yous adopt can bring it down another four to five points.

For people with stage 1 hypertension who don't have cardiovascular affliction and are at low take chances for developing it (less than 10% risk of an issue within 10 years), lifestyle changes are still the fashion to go. (Risk is determined using a well-researched, widely used formula available here.)

However, if a patient has whatsoever kind of cardiovascular illness and phase 1 hypertension (a claret pressure over 130 systolic or 80 diastolic), or no existing cardiovascular disease but a meaning adventure of developing information technology (over 10% hazard within the side by side ten years), and so lifestyle changes plus medications are recommended. And, even if someone has less than a ten% adventure, if their blood pressure is over 140 systolic or 90 diastolic, which is at present stage two high blood pressure, they ought to be treated with medication as well.

Optimizing treatment of loftier blood pressure

The authors bring several bear witness-based yet progressive concepts into the guidelines, the get-go of which is that high blood pressure level should be treated using a team approach. This makes sense, as science supports more and improve patient education effectually self-monitoring, nutrition, and lifestyle changes, every bit well every bit stress management. Telehealth is emphasized equally a cost-effective method of ongoing monitoring that is more convenient for patients than frequent office visits.

And why should this all affair to you?

Mountains of research over time have shown a very clear link between high blood force per unit area and cardiovascular illness. A 20-point higher systolic blood pressure level or a x-signal higher diastolic blood pressure is associated with double your hazard of death from a middle assail, stroke, or other cardiovascular complexity (like intestinal aortic aneurysm or heart failure). What many people don't realize is that those who survive these events find their lives permanently altered by disability and medical complications.

Much is being made of the fact that the new definitions of high blood force per unit area volition mean roughly half of all United states of america citizens volition exist considered to accept high claret pressure, but when y'all really expect at the numbers, equally cardiologists already have, not that many more people will really be advised to take medications. Although the public has good reason to be suspicious of "big pharma," that's non what this is virtually.

Diet and lifestyle changes are powerful medicine. Fifty-fifty if your blood pressure is normal at present, you can assistance to forbid it from becoming elevated starting today. Eat more fruits, veggies, and whole grains, and limit foods high in sodium and unhealthy fats. Be as physically active as possible.

There is a lot more in the very long, detailed executive summary, including specific guidance for various populations, myriad diseases, and special circumstances, merely this is the gist of it. The document is complimentary, and bachelor here.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please notation the date of last review or update on all articles. No content on this site, regardless of engagement, should ever be used as a substitute for directly medical advice from your medico or other qualified clinician.

Liz Feinauer

November 23, 2017

The American Middle Association recommends using up the corporeality of calories you consume with aiming for 150 minutes per week of moderate intensity exercise or 75 minutes of vigorous activity-or a combination of both. Dietary guidelines recommend eating a variety of nutritious foods from all nutrient groups including a multifariousness of fruits and vegetable, whole grains, depression-fat dairy products, skinless poultry and fish, nuts and legumes, and not-tropical vegetable oils. It is likewise recommended to limit the corporeality of saturated fats, trans fats, and sodium. In guild to lower claret pressure level, it is recommended to swallow more than than 2,400 mg of sodium (approximately 1 tsp of salt). Reducing sodium down to i,500 mg of sodium can reduce blood pressure level even farther, but reducing sodium intake by fifty-fifty but 1,000 mg per day tin can aid reduce blood force per unit area. Also it is recommended to non fume and avert secondhand smoking (American Centre Association, 2015). As a registered dietitian, these new guidelines and the emphasis on a healthy nutrition and lifestyle seem to me that it will lead to increased demand for dietitians who specialize in hypertension. Practise yous recall that this will increment the task market for dietitians and wellness coaches in this health area?

American Heart Association. (2015). The American Middle Association's diet and lifestyle recommendations. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WhbRcbS9-QA.

Dena Fob

November 27, 2017

Re " it is recommended to consume more than 2,400 mg of sodium"
I recollect you mean "no" more than 2,400 mg.

"While we ever knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading." So what? Does that hateful that someone's actually going to visit clinics all over the U.s.a. to make sure that BPs are taken several times during the visit? Is that going to be added to the skin inspections (that aren't done past the wellness care providers I take admission to) done at every "wellness" exam? And the questions regarding mental health/depression that aren't asked that are "now required"?

My BP gets taken one time, when I go far. Occasionally the top number is over 120. No health care provider has e'er said anything to me near it. Only In one case in the past 5 years, has any health care provider or banana taken my BP again during the course of the exam to come across if there'southward been a change. So by your defintion, I'g getting poor clinical care. And that means what? As in, what volition brand that modify? Information technology certain won't alter for me raising the issue, I'm lucky if the provider even speaks to me. Providers spend more time staring at monitors then looking directly at the client/patient in the examination room.

Char barton

November 21, 2017

Nosotros live on hype daily about many things. Goalsetters nosotros are. This is just another one, designed to raise our claret pressure almost yet another matter. We gotta alive/piece of work harder-better -smarter. Sleep the same manner. Dam. I feel my blood force per unit area rising already! Maybe less driven piece of work, play, judgment; more relaxing, letting it get, loving what nosotros are and have- is a better reply.

Stavros

Nov 21, 2017

Non only table common salt adds sodium to our food but too sodium glutamate, a flavor enhancer used in processed foods and restaurants. Does someone knows if this is as bad as adding salt?

Elaine Shiner

Nov 21, 2017

High-blood-pressure medications used to have a reputation for causing symptoms that were worse than the disease. I promise that situation has changed. I'thou sure that you're sincere when you write that this is non about more than medications, only, having observed the evolution of our wellness-care system for many decade at present, I'm skeptical.

Normal BP level (130/80) may not be uniform across all the regions of the earth owing to different life style and eating habbits. What is experts' stance on this?

Bhupender Kataria

November 21, 2017

Hi
What near our continued development? Are nosotros saying that man sapiens are stuck in fourth dimension ? Being a scientific discipline student I am totally puzzled. Our breadbasket was never made to digest wheat and rice and so many grains and pulseswe eat now only and then this how we evolved from the cave dwelling and flesh eating beings to what nosotros are today. Does any doctor estimated the systolic and diastolic of our ancestors ?

dr raj karwa

November 22, 2017

Katariaji, how come up jains are vegan only??
With evolution our intestines due north dentition are for veg n not for not veg
Dr karwa

Arnold Baise

November xx, 2017

It wasn't long ago (2013) that those over sixty were advised to aim for claret pressure beneath 150/90. Now, as a result of a single large trial, the numbers are being revised in a major style. But as Dr. Gilbert Welch has pointed out at https://www.nytimes.com/2017/xi/15/opinion/claret-pressure-guidelines.html , in that location are bug with this study. First, well-nigh eight% of patients aiming for 140 systolic (or less) had "cardiovascular events," whereas simply half-dozen% of those in the 120 systolic group did. This is simply a 2 point reduction, merely as a percentage it'due south a 25% reduction. This is the misleading use of per centum modify instead of actual alter. Second, the participants were already at higher than boilerplate risk for cardiovascular bug, and then information technology was a study of a selected group and not of the general population.

Doc Mil

November 21, 2017

A reduction from 8% to half dozen% of cardiovascular events is known equally an absolute risk reduction of 2%. This may seem small, but the translation is not pocket-sized when applied to real world people. This can be understood more easily as something called "number needed to treat" which is calculated past ane divided by the accented risk reduction. In this instance, an absolute risk reduction of 2% translates to a "number needed to treat" of 50 (1 divided by 0.02 = 50). This means that 50 people need to take a BP down to < 120/eighty in order for 1 cardiovascular event to exist prevented. In the context of many other things nosotros do in our life (medical handling or not), this is really good!

For case, did y'all know it takes x,000 mammograms done yearly for 10 years, in order to just forestall ten breast cancer deaths?
https://jamanetwork.com/journals/jama/fullarticle/2040228

Of notation, I am a primary care physician.

Grace Williams

November 20, 2017

Grace Williams
I'one thousand but turn 56 years and for the past eight month my blood force per unit area was high, now it is even dangerously loftier. Was 154 over 82 now it'southward 189 over 82 or 92 . Information technology really scares me, I know that I tin have a stroke or eye attack. My weight is 191 and my height is 5'7. Eats wellness. No meat or dairy. But stress out from work. Need some help.

Exercise may help. Walking at a brisk step for i/2 hour nearly days, so adding 15 minutes to the walk every week. It doesn't accept to be washed all at once-walk 15 minutes in the morning time, 15 at lunch, and fifteen after supper. Get a friend or neighbour to walk with you and the time will become by quickly.

What nearly the food industry? I cook almost all my meals, when I go out to eat, if I do not specify no seasoning, I tin't even take ane bite due to the excessive amount of salt added to the food.
I think at this signal whatever eating place or food industry that adds excessive salt should exist taxed commensurately to aid defray the cost for wellness care. The salt is killing us.

I travel extensively, and our state by far uses as well much salt in processed and restaurant food.

Perhaps you lot tin can can help brainwash people and strength the nutrient industry to change! I can only promise.

Give me a suspension. Most people don't use restaurants for their every-twenty-four hours eating— it's a special occasion intended to exist more indulgent than a normal meal. Your distaste for common salt shouldn't affect the level of seasoning in my Birthday dinner.

I concord. Eating at home is the simply sure way to keep your bp downward. Manner likewise much salt in restaurant meals.

Jeanne Miller

Nov twenty, 2017

Why do I get up in the AM with enormously high B P? Commonly 180 over 85 with a 53 pulse?

Monique Tello, Md, MPH

Nov xx, 2017

Fantabulous betoken! I tin can't speak for anyone specifically, but I tin say that generally, doctors make the worst patients. We don't always follow the textbook guidelines nor abide by health recommendations. Then, there'southward genetics, a pretty powerful forcefulness, and i over which nosotros have little control. And, of course, there is just plain bad luck (or fate, finger of God, all the same y'all cull to describe it). And then, many factors can come up into play when a physician gets diagnosed with what can otherwise exist considered a preventable disease.

Sara Shannon

November 19, 2017

Please stop saying "unhealthy fats." Tell people what the sources of those unhealthy fats are specifically.

Monique Tello, MD, MPH

Nov 20, 2017

Very good point! This August 2017 post all about dietary fat will hopefully tell yous everything you want to know:
https://world wide web.wellness.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good

Sotirios

Nov 17, 2017

If yous and your colleges at AHA are right about cvd, how come up their president got a heart attack recently? Get real and level with us tha you do not know what is the cause and next u don't know how to prevent or treat it correct ,

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Source: https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756

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