At age 40, more than half of Americans have high blood pressure, but many don’t know it. Hypertension has long been known as the silent killer. When untreated, it can be deadly. And it’s considered a silent threat because most people show no symptoms. You don’t feel the pressure in your blood vessels increasing.
New recommendations from the American Heart Association aim for early treatment, including lifestyle changes and medications, as soon as systolic blood pressure exceeds 130/80 mm Hg, which means millimeters of mercury, a measure of pressure. Experts say it’s clear that the earlier you act, the more you can protect yourself.
Hypertension is one of the leading causes of heart disease, which is the number one cause of death for both men and women in the US. High blood pressure also increases the risk of kidney disease and dementia. And research shows that hypertension can lead to damage in small blood vessels in the brain, which is linked to cognitive decline.
“There’s a huge opportunity for preventive health in treating hypertension earlier,” says Dr. Jordana Cohen, nephrologist and hypertension specialist at the University of Pennsylvania. She says millions of adults in the US could benefit from medications and lifestyle changes.
“If you detect it early and treat it early, you can end up with many more years of healthy life expectancy,” says Cohen, pointing to a reduced risk of heart attacks, strokes, kidney damage, and dementia.
The new guidelines highlight decades of advice on the benefits of a low-sodium diet, which can be challenging to follow, given that more than half of the calories consumed in the US come from ultra-processed foods, which tend to be high in salt.
The new guidelines also emphasize lifestyle strategies, including exercise, limiting alcohol consumption, and reducing stress through meditation, yoga, or deep breathing. For people with systolic blood pressure (the top number) in the 130 range, the recommendation is to start with these diet- and lifestyle-related changes, then move to medications if blood pressure doesn’t improve.
For people who reach the systolic blood pressure risk range of 140 or higher, considered stage 2 hypertension, evidence shows that starting with blood pressure medications is beneficial.
“For all people with blood pressure above 140/90 mm Hg, we recommend starting with two medications,” said Dr. Dan Jones, chair of the guideline writing committee for the Heart Association, to NPR. Research shows that one medication alone is often not enough to lower blood pressure to the ideal range, he says.
Jones says that even when people know they have hypertension, more than half fail to lower it to the normal range, which is 120/80 mm Hg or less. Some of the challenges include medication side effects and individual differences in how well the medication works, as well as reluctance to take pills among some people. Additionally, some people struggle with the everyday obstacles of making lifestyle changes. Jones notes that healthcare professionals also use a risk calculator to estimate a person’s individual risk of heart disease as part of a treatment plan.
When George Solomon was told about the risks of high blood pressure, he hesitated to take medications. “I felt fine,” he says. Then, at age 63, he had a stroke.
Solomon had retired from a career in law enforcement and was adjusting to a new routine, making time for exercise and hobbies, like splitting wood on his farm. One day in the spring of 2023, he started feeling unwell.
“I went upstairs to watch TV, and when I sat in the chair, I couldn’t get up. I felt a sensation that went up my back,” he recalls, and he lost sensation in his arm and leg. An ambulance took him to Duke University Hospital, near his home, where he underwent stroke treatment and rehabilitation.
He estimates he’s now about 80% recovered and back to exercising and working on his farm. He now realizes he needs healthy lifestyle habits and medications to prevent another stroke.
“I feel like I’m on the right track,” he says. He’s lost weight and is doing more cardio and strength training. He’s sharing his story in the hope that it encourages others to take action.
Medications: what’s available, what’s coming
There are several types of medications used to treat hypertension. They include diuretics that help the body get rid of extra salt and water, ACE inhibitors that help block the production of a hormone called angiotensin II and help relax blood vessels, and calcium channel blockers that slow the movement of calcium into cells, which can help reduce pressure.
But many people with hypertension don’t get enough reduction with current medications, and Cohen from the University of Pennsylvania says there’s a lot of interest in a new class of medication that works by targeting the hormone aldosterone, which helps regulate fluids and sodium in the body. Too much of this hormone is a cause of high blood pressure. The medication isn’t on the market yet, but new study results could pave the way for a new treatment option.
“In hypertension, we haven’t seen anything new that’s effective since the 90s,” says Cohen. So another tool in the treatment kit could be beneficial, she says.
A study published in the New England Journal of Medicine found that the aldosterone blocker medication known as baxdrostat was effective in lowering blood pressure in many people who have trouble controlling their hypertension.
The study included about 800 people who, despite taking two or three medications, still hadn’t lowered their blood pressure to the normal range. “What we saw is that after 12 weeks of treatment, there was an improvement of about 10 points in blood pressure in patients treated with baxdrostat compared to the placebo effect,” said Dr. Jennifer Brown, cardiologist at Brigham and Women’s Hospital and one of the researchers behind the study, to NPR. The study was sponsored by the pharmaceutical company AstraZeneca, which plans to share its data with regulatory authorities by the end of the year.
A drop of 10 points in systolic blood pressure is linked to about a 20% reduction in the risk of heart attacks and strokes and also a decreased risk of dementia.
Source: npr.org by Allison Aubrey