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What to Do if Your Blood Pressure Is 'Elevated': Elevated blood pressure and stage 1 hypertension require lifestyle changes and, for some people, a more nuanced treatment approach.

Your blood pressure is a continuum reflecting increasing cardiovascular risk as the numbers rise.

That being the case, consider elevated blood pressure as a potential herald of hypertension, a major risk factor for heart attack and stroke.

An elevated blood pressure reading is also a call for you to make lifestyle changes that may slow your advance toward hypertension and the need for medical therapy. As recent research suggests, adhering to a heart-healthy lifestyle may help you reduce your blood pressure without medications.

"If your blood pressure is in the elevated category, if you follow lifestyle modifications, you can delay the progression into a hypertensive category," says George Thomas, MD, a blood pressure specialist with Cleveland Clinic's Department of Nephrology & Hypertension. "Certainly, lifestyle modifications should be emphasized in that category because you may be at increased risk down the line."

Farewell Prehypertension

For years, medical experts recognized prehypertension: systolic blood pressure (the top number in the reading) of 120 to 139 millimeters of mercury (mraHg) or diastolic pressure of 80 to 89 mmHg. Studies suggest that people with blood pressure in the prehypertensive range aren't in the clear: They're more likely to advance to hypertension and also face a greater risk of cardiovascular disease, heart attack, and stroke.

So, 2017 guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) eliminated the prehypertension category and replaced it with two classifications:

* Elevated blood pressure: 120 to 129 mmHg systolic and less than 80 mmHg diastolic.

* Hypertension stage 1:130 to 139 mmHg systolic or 80 to 89 mmHg diastolic.

Although the names are different, the risks remain the same. "One of the reasons they changed the terminology was the prehypertension category sounded like it was too benign when it wasn't completely benign," Dr. Thomas explains. "Those folks were at risk for full-blown hypertension in the next five years or so, especially if they were in the higher range of prehypertension."

Rein in Your Blood Pressure

The guidelines stipulate that lifestyle changes alone are warranted to manage blood pressure in the elevated range (see "What You Can Do," on page 1).

Management of stage 1 hypertension is more nuanced. If your blood pressure falls in this range and your 10-year risk of heart disease and stroke is less than 10 percent based on the AHA/ACC atherosclerotic cardiovascular disease risk calculator, your physician should recommend lifestyle changes and reevaluate you in three to six months. However, if your risk is 10 percent or higher, or if you're age 65 or older, have cardiovascular disease, diabetes, or chronic kidney disease, your doctor should prescribe an antihypertensive medication plus lifestyle changes and reassess you in one month, the guidelines state.

"All of this plays into your potential risk down the line," Dr. Thomas advises. "Whatever we can do to keep these blood pressure levels in check would be beneficial, and if we can do that with lifestyle changes, that would be best, without having to add medications."

A key lifestyle change is adopting a heart-healthy diet, such as the low-sodium, high-potassium Dietary Approaches to Stop Hypertension (DASH) eating pattern, which emphasizes consumption of fruits, vegetables, whole grains and lean protein sources.

In a recent study, researchers reported that among 129 overweight or obese men and women with hypertension, following a DASH diet (with or without weight loss) led to significant lowering of blood pressure and reductions in the percentage of people who met indications for antihypertensive medical therapy (American Heart Association Hypertension Scientific Sessions, Sept. 8, 2018).

"The DASH diet and weight management are proven lifestyle modifications," Dr. Thomas says. "The study reinforces the point that if lifestyle modifications are truly followed, there definitely is a benefit from a blood-pressure-control standpoint, to the extent where medications might not necessarily be needed."

Track, Tailor Your BP Control

Dr. Thomas recommends home monitoring for anyone with blood pressure in the elevated or stage 1 hypertension categories, in addition to those with higher blood pressure. No optimal blood-pressure-monitoring schedule has been uniformly endorsed, but he suggests checking your blood pressure two to three times a week when you wake up and before going to bed. Get two or three readings each time, and share your results with your physician.

"If you check it at home, at least you're aware there is a trend if the blood pressure is going up, and you can notify your providers," he adds. "Essentially, you're involved more in your care, and individually you have more control of your own health."

Keep in mind that the AHA/ACC guidelines are just that, and not all medical experts endorse them. So, although following a healthy lifestyle is advised for everyone, regardless of blood pressure category, decisions about whether to begin medical therapy, the choice of medication, and how low you should reduce your blood pressure should be tailored to your unique needs and medical condition, Dr. Thomas emphasizes.

"Someone once said that biology cannot be put into boxes. The thing with blood pressure is it's a linear risk. These risk categories help us decide on treatment modalities, but even so, there is no clean separation," he says. "These guidelines give us a framework, but practitioners should definitely look toward individualizing care."


* Reduce your sodium intake to less than 2,300 mg per day, Dr. Thomas advises. Put away the salt shaker, and limit your intake of processed or packaged foods. If your food comes in a can, box, jar, or plastic packaging, odds are it's high in sodium.

* Adopt a regular physical activity regimen, including 30 to 45 minutes of aerobic physical activity a day on most days of the week and strength training on two to three nonconsecutive days a week.

* Maintain a healthy weight, and lose weight if you're overweight or obese. Usually, each 2.2 pounds of weight loss results in a 1 mmHg reduction in blood pressure, according to the AHA/ACC guidelines.

* If you drink alcohol, limit your intake to no more than two drinks a day (one or fewer daily for women).

* Seek an evaluation if you have signs of obstructive steep apnea (OSA), such as loud snoring and excessive daytime sleepiness. OSA is linked with an increased risk of hypertension and cardiovascular disease.

Caption: When you check your blood pressure at home, be sure to get the right size of cuff for your arm (not too tight or too loose) and an accurate monitor. Periodically have your physician check your monitor and review your technique for checking your blood pressure to ensure you're measuring it correctly.


Normal          <120 mmHg systolic and <80 mmHg diastolic

Elevated        120-129 mmHg systolic and <80 mmHg diastolic

Stage 1         130-139 mmHg systolic or 80-89 mmHg diastolic

Stage 2         [greater than or equal to]140 mmHg systolic or
Hypertension    [greater than or equal to]90 mmHg diastolic

Hypertensive    >180 mmHg systolic and/or >120 mmHg diastolic

Hypertensive    >180 mmHg systolic and/or >120 mmHg diastolic
Emergency       with signs of organ damage
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Publication:Men's Health Advisor
Geographic Code:1USA
Date:Jan 1, 2019
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