Blood Pressure Management: Guidelines & Tips

As you’ve probably heard, the guidelines that doctors should be considering to decide whether your blood pressure is “normal” or high have changed in the past couple years. Whereas anything less than 140/90 used to be reasonably okay for the majority of adults out there, the new guidelines have been criticized for being overly strict. So what are they? In general, the categories are now as follows:

With these new categories, about 50% of adults over 40 will be classified as having at least elevated blood pressure, according to the American Heart Association (AHA)! Many have argued that for this reason it’s just a ploy to be able to prescribe more medications. They argue it’s quite the contrary though. Instead, by being able to classify more people with high blood pressure starting at lower numbers, this will provide the opportunity for many more to have recommendations to implement lifestyle changes earlier on. In fact, these lifestyle changes such as the right diet and exercise can lower blood pressure by as much as about 10 points. With that in mind, the number of people for whom a prescription medication is recommended to treat blood pressure actually isn’t much higher than it was before.

Before we get into what you can do about your blood pressure, let’s get into the nitty gritty of what blood pressure actually is. Then we can talk about why it matters and what you should do about it.

What is it?

Blood pressure is the result of the amount of fluid going through your blood vessels as a factor of how tight the blood vessels are – the resistance. Without getting into too much of the Physics, the easy way to think about why this matters is by using the analogy of lifting weights. No, this isn’t the age old trick question of whether it’s easier to lift a bag with a pound of rocks or a pound of feathers (it has to be the feathers, right?). Think of it in terms of whether it’s easier to carry a bag filled with rocks or an empty bag. Now put that in the perspective of your heart and blood vessels, which have to carry that load 24 hours per day, 7 days per week for your entire life. Of course, offloading the pressure too much – or causing very low blood pressure – might mean that there isn’t enough pressure to keep blood flowing to all of your organs given that us humans are upright and gravity is relentless. (Think of living on the top floor of a high rise versus the first floor if the water source is in the basement… your shower water pressure will be a lot better on the first floor.) However, blood pressure that’s too high forces your cardiovascular system (your heart and blood vessels) into overdrive in order to deal with it. Over the course of years, this can cause irreversible changes if left unchecked.

How should you check it?

Checking blood pressure isn’t as straight-forward as it may seem. Often times, doctors’ offices don’t even check it correctly. There’s more evidence that the best way to check blood pressure is throughout the day, multiple times with something called an ambulatory blood pressure monitor. It checks your blood pressure intermittently throughout the day and night while you do different activities to get a full range of what your blood pressure is actually like. This probably better represents your true numbers as opposed to the classic guideline-directed way of checking it in a quiet room in a seated position after you’ve had time to relax. A good, easy compromise between wearing a continuous monitor and checking in your doctor’s office all the time is to get yourself a good home blood pressure monitor. You can check your blood pressure daily and keep a log of the day, time, heart rate, blood pressure, and if you have any symptoms (such as pain, anxiety, headache, etc).

What should you do about it?

If you’re in the Normal category, great for you! It doesn’t mean you’re off the hook though. You’ll want to maintain a healthy diet and a regular exercise regimen to ensure that you stay as healthy as possible for many years to come. Since heart disease takes years to decades to develop, the sooner you start with healthy lifestyle changes, the better.

For those in the Elevated category, here’s your wake-up call. Blood pressure’s relationship to cardiovascular disease is directly related meaning that the higher it gets, the higher the risk. Although being in the category is certainly not a high risk situation, it’s an opportunity to really take advantage of the benefits that healthy lifestyle changes can have. By implementing a heart-healthy diet and an exercise program targeted at lowering your blood pressure, you could very well find yourself in the Normal category within a few weeks to months.

If your blood pressure falls into one of the Hypertension categories, fear not! Depending on your risk factors and how high your blood pressure is, you may be able to start with lifestyle changes to see if that brings you down to a normal range. However, most people in Stage 1 require at least one medication and most people in Stage 2 require two or more medications in order to control their blood pressure. The worst thing you can do is blame yourself for this and think of taking medications as a failure on your part. If that thought crossed your mind, let it keep crossing until it’s far gone. Many things factor into what your blood pressure is: diet, exercise, weight, stress level, hormones, age, sex, genetics, etc. While you can modify some of these factors, there are a good number of them we refer to as non-modifiable risk factors for heart disease, several of which are associated with higher blood pressure. While these things certainly aren’t your fault, it’s crucial to know about them because there are medications out there nowadays that you can couple with those important lifestyle changes to help you bring your blood pressure down to the normal range, essentially “curing” your high blood pressure. If you do take medication for hypertension and it’s working, don’t stop! Medications only work if you take them. It’s not like an infection where once you treat it for a little while, you’re good to go.

Furthermore,  just because you take a medication doesn’t mean it replaces a good old fashion healthy lifestyle ((the best medicine of all).

Speaking with your doctor regularly to make sure you’re meeting your treatment goals is important since most people will require adjustments in their medications over time.

Key dietary changes you can make to help lower blood pressure are to decrease the amount of salt and red meat you eat. Salt has a tendency to hide in a lot of foods so it’s important to look at the nutrition labels of what you’re eating to truly get a sense of how much you’re taking in. Common offenders are processed foods such as deli meats or sausages, pasta sauce, and soup. You’ll want to aim for less than 2 grams of salt (sodium) per day if you’re looking to have an effect on your blood pressure. 

If you’re worried that food won’t taste good without much salt, you’re in luck! Some great alternatives to salt that can really pack some flavor into food are garlic powder (not garlic salt) and salt-free seasoning mixes such as Mrs. Dash. Replace your salt shaker with those on your dinner table and you won’t even remember what salt is. If you really must have some of that salty flavor in your food, try potassium-based salt products instead of the usual sodium-based table salt.

Exercise

When it comes to exercise for blood pressure control, it’s important to add in resistance training to your workout plan. The new guidelines put forth by the AHA recommend 2.5-5 hours of moderate intensity physical activity that includes aerobic activity most days of the week and strength/resistance training on two or more days of the week. Basically, you’ll want to try to do some form of physical activity such as brisk walking, jogging, swimming, or biking that’s hard enough where you can’t say more than a few words without needing to take another breath. Then at least a couple days per week, you’ll want to do something like weights, squats, or yoga where you’re actually working on different muscle groups. 

Aerobic exercise is important for your blood pressure because it gives your heart a workout that makes its usual job of pumping easier. Strength training is just as important though because as you work out individual muscles in your body – called skeletal muscles – the muscles grow and more blood can flow to them. As more blood flows to more places in your body, your overall blood pressure will go down. A good analogy for this is the water pressure flowing through your tap when you just have the sink running versus when you have every sink and shower running at the same time. When the water has to go to a lot of different places, the water pressure goes down… a concept that’s not good for your morning shower, but great for your blood pressure.

Summary

The job of Cardiologists is to individualize the guidelines. More than that, one single blood pressure reading that is elevated does not necessarily mean someone has a diagnosis of high blood pressure (hypertension). Even further, just because the guidelines classify blood pressure into these categories doesn’t mean that everyone has the same blood pressure goals. It very much depends on each individual person’s other medical issues as well as some other considerations. 

All that said, as long as your doctor said it’s safe to do so, the first steps in lowering blood pressure are recommendations that everyone should follow. This includes lifestyle changes such as diet, exercise, and weight loss (if appropriate).