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How the new BP guidelines affect you.

The new blood pressure (BP) guidelines issued this year have many seniors wondering if they need to continue their medication. The guidelines, published in a Journal of the American Medical Association report, raised the systolic BP (the top number of the BP reading) for high blood pressure for anyone age 60 and older, from 140/90 mm Hg to 150/90 mm Hg. (For people with diabetes or chronic kidney disease it remains at 140/90 mm Hg.) What does this mean for the estimated 6 million people who take medication to treat mild hypertension?

"If you are already being treated for high blood pressure, and it is well controlled, then the new guidelines do not have much impact on you," says Sonja Rosen, MD, Chief of Geriatric Medicine at UCLA-Santa Monica. However, for many it could mean they are now eligible for less intensive BP medication and/or lower dosage, while others not yet diagnosed with hypertension, or who are borderline, may be able to avoid drug therapy.

BP is a continuing health issue. Blood pressure is the force exerted on your arteries by blood being pushed through from the heart. Two measurements are used to gauge BP, with each recorded in millimeters of mercury (mm Hg). Systolic pressure gauges the pressure in the arteries at systole, the moment when the heart contracts to push the wave of blood through the arteries. Diastolic pressure, the bottom number, is the pressure during diastole, or the brief period of relaxation between heartbeats.

High blood pressure, or hypertension, continues to be a serious issue for many older adults. "It is something most people can't avoid as they age because their arteries naturally become harder," says Dr. Rosen. About 67 million Americans, or one of every three adults, have high blood pressure, according to the Centers for Disease Control and Prevention. Those age 65 and older make up the largest group, with 64 percent of men and 69 percent of women ages 65 to 74 having high BP.

"When BP runs high it means the body works harder to move blood around, and this in turn puts stress on the body and many vital organs, including the brain, heart, and kidneys," says Dr. Rosen. "Therefore, poorly treated blood pressure can result in heart disease, stroke, and/or kidney disease." High BP can also lead to damaged blood vessels in the eyes, and vascular dementia, which is the second leading cause of memory loss and cognitive problems.

Medication Still helps. Doctors continue to advocate lifestyle changes to manage elevated BP, such as weight loss, if necessary, diet modifications (including reducing salt intake and eating more antioxidant-rich fruits and vegetables), and staying physically active.

Sometimes that may not be enough and BP medications are prescribed even for mild hypertension. BP medications work in different ways. (See "Know Your Blood Pressure Medications" below).

Doctors usually begin with the lowest possible dosage and increase as needed until the blood pressure drops to healthy levels. Since some medications may not help your BP, or cause intolerable side effects, you may need to try several types, or combinations, until you find what works best.

What does all this mean for you? The new guidelines may or may not affect you. Still, you should use this opportunity to re-examine your BP management even if you do not have high BP and are not taking medication at the moment. Here is what you need to do:

[1] Get your BP checked, especially if you haven't before. People often avoid checking their BP because they are afraid. "If it's high and they have to go on BP medication, they may think something is seriously wrong with them," says Dr. Rosen. "But this is a good opportunity to embrace your BP and take action if it's needed." For instance, even if you do not have high BP, you may suffer from low BP, especially if you weigh 150 pounds or less, or have diabetes. "This puts you at a higher risk of falls as you may get light-headed or dizzy when you stand," says Dr. Rosen.

[2] Check your BP regularly. Your doctor will check it during your routine office visits, but it is a good idea to measure it yourself every few months. You can do this with a home monitor, but make sure you check it when you first wake up as this is when your BP is highest.

"Also, check it when you are standing and not sitting," says Dr. Rosen. "Sitting can make your BP slightly spike, so you won't have an accurate reading." And while the BP machines found at most drug stores are not always 100 percent accurate, they still can give you a close measurement, says Dr. Rosen. "Just compare them with the number you get from your doctor."

[3] Speak with your doctor about your medication. Even if you now fall into the safe zone, your doctor may still want you to continue your medication, because your BP would be harder to control without it, says Dr. Rosen. "Once people are on BP medication, they often are not taken off unless they have an issue related to falls, or some other serious side effect," she says. "There also can be other potential dangers for abruptly stopping regular medication, including strokes related to high blood pressure."


MEDICATION                  POTENTIAL SIDE              NAMES

DIURETICS: These         A potential side       Lozol (generic--
  increase the           effect of extra        indapamide);
  kidney's elimination   urination that comes   Hygroton
  of salt, and water,    with diuretics is      (chlorthalidone);
  through urine          the loss of key        HydroDIURILand
  output. This loss of   minerals, such as      Esidrix
  fluid decreases        magnesium and          (hydrochlorothiazide);
  overall blood          potassium. Other       Lasix (furosemide);
  volume, thereby        potential side         Diuril
  reducing some of the   effects include        (chlorothiazide).
  pressure on blood      headache, upset
  vessel walls.          stomach, sun
                         dizziness, and
                         appetite loss.

BETA BLOCKERS: These     Nausea, stomach        Lopressor and Toprol
  drugs interrupt, or    cramps, depression,    XL (metoprolol);
  block, specific        sleep disturbance,     Corgard (nadolol);
  command signals to     sexual dysfunction,    Tenormin (atenolol);
  cells in the walls     dizziness and          Sectral
  of blood vessels and   blurred vision.        (acebutolol); and
  heart muscles. The                            Monocor
  result eases the                              (bisoprolol).
  need for the heart
  to pump so hard to
  push the blood
  through the system.

ACE (angiotensin-        Muscle weakness,       Vasotec (enalapril);
  converting enzyme)     headache, dizziness,   Prinivil and Zestril
  INHIBITORS: As with    and sleepiness. Some   (lisinopril);
  beta blockers, ACE     can cause a cough or   Accupril
  inhibitors interfere   rash.                  (quinapril);
  with the body's                               Lotensin
  production of a                               (benazepril); and
  chemical that                                 Capoten (captopril).
  naturally constricts
  blood vessels. This
  eases blood flow,
  which lowers

ARBs (angiotensin II     Sleepiness,            Atacand
  receptor blockers):    headache, dizziness,   (candesartan);
  Similar to ACE         diarrhea, rash, and    Teveten (eprosartan
  inhibitors, they       potassium buildup in   mesylate); Diovan
  work to halt the       the blood.             (valsartan);
  action of                                     Micardis
  angiotensin, the                              (telmisartan); and
  vessel-constricting                           Cozaar (losartan).
  chemical, rather
  than inhibit its
  formation. As with
  ACE inhibitors blood
  vessels are open
  wider, which
  decreases pressure.

CALCIUM CHANNEL          Headaches,             Cardizem
  BLOCKERS (Calcium      dizziness, nausea,     (diltiazem); Cardene
  Antagonists): Keeps    and rashes. Others     (nicardipine);
  calcium from           include                Plendil
  entering the artery    constipation,          (felodipine); Calan,
  and heart cells,       flushing and edema     Covera-HS, Verelan
  which open up the      in the legs and        (verapamil); and
  blood vessels, and     feet.                  Norvasc (amlodipine
  lowers pressure.                              besylate).

RENIN INHIBITORS:        Diarrhea, headache,    Tekturna
  Renin is an enzyme     dizziness, and         (aliskiren).
  that interacts with    cough. In rare cases
  angiotensin to         these drugs can
  constrict blood        affect breathing and
  vessels and ease       cause swelling in
  blood flow.            the face.
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Publication:Healthy Years
Date:Oct 1, 2014
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