People with slightly high blood pressure may need medication

People with blood pressure that's a little too high should take medication to bring it down if lifestyle changes alone don't work, according to a new report.

The American Heart Association published the scientific statement Thursday in its journal Hypertension. It said doctors should consider prescribing blood pressure-lowering medication to people with stage 1 high blood pressure – a top number of 130-139 or a bottom number of 80-89 – who are unable to bring levels down after six months of lifestyle changes such as regular exercise and a healthy diet.

In 2017, the American College of Cardiology and American Heart Association issued blood pressure management guidelines recommending people with stage 1 hypertension and a low risk for heart attack or stroke within 10 years first try to lower their blood pressure with healthy lifestyle changes, then check levels again in six months. But the guidelines didn't say what to do if that strategy doesn't work.

The new guidance fills that gap. It would apply to nearly 10% of U.S. adults with high blood pressure.

The statement includes a range of healthy behaviors to lower blood pressure: achieving ideal body weight; exercising; eating less sodium, enhancing potassium intake and following Dietary Approaches to Stop Hypertension. Also called DASH, it includes fruits and vegetables, low-fat dairy products and less saturated fat and total fat. Other changes include limiting alcohol and not smoking.

"We know that people with blood pressure lower than 130/80 mmHg have fewer markers of cardiovascular risk like elevated coronary calcium, enlargement of the heart, or buildup of fatty deposits called atherosclerosis in arteries of the neck," Dr. Daniel W. Jones, chair of the statement writing group, said in a news release. He is professor and dean emeritus at the University of Mississippi School of Medicine in Jackson.

"There is strong evidence that treating high blood pressure saves lives by reducing the risks for heart attack and stroke," he said.

People working to lower blood pressure should check it regularly to monitor progress, Jones said. "If they don't achieve average daily systolic blood pressure less than 130 mmHg, it's probably time to initiate a conversation with their doctor about practical next steps, which may include adding medication, to manage their blood pressure."

The statement acknowledges that lowering blood pressure through lifestyle changes alone isn't easy.

"It is very hard in America and most industrialized countries to limit sodium sufficiently to lower blood pressure," Jones said. "And it is difficult for all of us to maintain a healthy weight in what I refer to as a toxic food environment. We want clinicians to advise patients to take healthy lifestyle changes seriously and do their best.

"We certainly prefer to achieve blood pressure goals without adding medication," he said. "However, successfully treating high blood pressure does extend both years and quality of life."

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