New Guidelines Bump Up Pool of Patients with High Blood Pressure

Lilo H. Stainton | November 22, 2017 | Health Care
‘Elevated’ blood pressure, a new category, should respond well to lifestyle changes like diet and exercise

blood pressure
Hundreds of thousands of New Jersey residents may soon discover they are now considered to have elevated blood pressure — and that lifestyle changes alone might keep the potentially deadly condition under control.

Doctors believe that new, tighter guidelines for high blood pressure released last week will lead another 30 million Americans to be diagnosed with hypertension, or high blood pressure, which raises the risk for heart disease, diabetes, stroke, and other serious health problems.

But most of these new patients are not likely to be prescribed medication to address these concerns. Instead, experts said many individuals should be able to reduce or control their blood pressure with a better diet, more exercise. and habit changes, like quitting smoking.

Beyond the doctor’s office

The recommendations, developed by the American College of Cardiology and the American Heart Association over a number of years, also reflect a growing interest in wellness and disease prevention. The trend – largely embraced by state health officials in New Jersey — accepts that healthcare must extend beyond the doctor or hospital into patients’ daily lives, and it has resulted in more attention and resources for nonmedical components of care.

The new guidelines define “normal” blood pressure as anything under 120/80 (millimeters of mercury); previously this line had been set at 140/90. Patients who test above 140/90 are considered to have “high” blood pressure and should generally be treated with medication and lifestyle changes, the groups recommend.

Not high, ‘elevated’

The guidelines also establish a new category — “elevated” blood pressure — to describe those who fall between the two readings; providers are urged to address diet, exercise, and other factors before prescribing any pills to this cohort.

“Many more people will be considered hypertensive and therefor qualify for treatment” as a result of these revisions, explained Dr. Andrew Weissman, a cardiologist at Englewood Hospital and Medical Center. “But it also changes who we target for what treatment.”

Nationwide, some 72 million Americans are already diagnosed with hypertension, a disease that often has few symptoms but can cause serious damage to blood vessels and other organs. In New Jersey, nearly 31 percent of residents — almost 2.3 million people — have already been told they have high blood pressure. (Among black residents the rate is more than 40 percent, both in state and nationwide.)

, data compiled by the UnitedHealth Foundation, hypertension has been rising steadily nationwide — and in New Jersey — for nearly two decades. In 1998, less than one-quarter of the population had been diagnosed with high blood pressure.

‘A silent disease’

“High blood pressure is a silent disease,” Weissman said. While low blood pressure can cause dizziness and other symptoms, high or elevated pressure doesn’t always come with a clear warning.

“The idea [behind the new guidelines] is that even when you are in that borderline range, you are at increased risk for getting hypertension in the future,” he added. Higher readings involve far more danger and more complex, and costly, treatment.

Given the relatively low cost of the test — and the far-reaching benefits associated with the lifestyle changes prescribed as treatment — there is little risk associated with false positives or over-diagnosing the disease, Weissman and others said.

But with the pool of hypertensive patients set to expand significantly, doctors concede they have real challenges ahead. Only half of those already diagnosed with high blood pressure have been able to keep the condition well controlled, experts note.

James Matera, a doctor of osteopathy at CentraState Healthcare
James Matera, a doctor of osteopathy at CentraState Healthcare, in Freehold, said one thing is clear: physicians cannot do this alone. CentraState launched a hypertension initiative recently that involves health coaches and other professionals who work with patients over 12 weeks on disease management, nutrition, wellness, and other lifestyle factors.

“We’ve had great results,” Matera said. Blood pressure numbers dropped and “it was a good risk reduction in this group of patients,” he said. “It showed that our health coaches are really dedicated to what they are doing.”

The new guidelines, Matera noted, are designed to reduce the risk of high blood pressure and related problems among a far larger group patients. “This is exactly what this (CentraState hypertension) program is designed to do,” he added.

CentraState is certainly not alone in its approach. The Trenton Health Team is part of a collaboration that involves the local YWCA, city officials, and other partners that has planted community gardens, opened a farmers market, and expanded healthy options at corner stores in an effort to address obesity and other health issues.

Newark Beth Israel Medical Center — which serves a population with extremely high blood pressure and other medical concerns — operates a wellness program that planted an urban garden and built a hydroponic greenhouse, where cooking and nutrition classes are held. The hospital is part of the RWJ/Barnabas Health network, the state’s largest, which has taken a proactive approach to population health on many fronts.

“There’s always going to be inpatient care,” Matera noted. “But if we can manage a lot of these conditions with higher outcomes and lower costs prior to admission, it’s going to be crucial.”

“I truly feel like we are moving the needle,” he added.