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What's New in Hypertension?

"Keep up on high blood pressure"
By: Ivan Olegario, MD, MDevComWhat's New in Hypertension?

As more studies on hypertension (high blood pressure) are conducted by scientists, our knowledge on hypertension continues to grow. New knowledge may mean changes in how we treat high blood pressure.

High blood has been defined for many years now as a blood pressure (BP) of greater than 140/90 mmHg. It follows that treatment of high BP means pushing your BP to normal levels, meaning lower than 140/90 mmHg. However, JNC 8 recommends that if you are aged 60 years old or older and does not have diabetes or kidney disease, your target BP may be increased to 150/90 mmHg. What does this mean? Before, someone aged 60 years with that BP would need additional medications. However, with JNC 8, your doctor may now choose to maintain your current medication.

Many physicians may still choose to lower BP further (to less than 140/90 mmHg, but JNC 8 reminds us of moderation. Those with older age generally have higher BP, and are also more prone to the side effects of BP-lowering drugs. A balance between BP control and side effects, including avoidance of dangerously low BP, should be the goal.

If you have hypertension, what do all of these mean for you? Two things.

First, monitor your BP regularly, even in the absence of any symptoms. Home BP monitoring is usually better, since your BP can be measured in a relaxed environment. Many people become so nervous in doctors’ clinics that their BP shoots up for no other reason.

Secondly, be conscious of the effect of your medications on your body, and communicate any side effects to your physician. It is only by telling us what you feel that we will be able to know of any concerns you may have, and make the necessary adjustments.

A last note on target BP, the JNC 8 recommends that you should take BP control very seriously. You should reach your target BP within one month of starting treatment. This may mean frequent clinic visits during this time so that your physician may adjust your treatment in a timely manner, but once you reach your target BP, you can relax a little bit.

Hypertension is a lifestyle disease. It has always been, and it will always be. As with the previous guidelines, JNC 8 emphasizes the importance of lifestyle changes in the treatment of hypertension.

These include:

  • Eating using the Dietary Approaches to Stop Hypertension (DASH) eating plan, which can lower your BP by 14 mmHg.
  • Weight loss. This can make your BP medications more effective.
  • Reduction in sodium intake to less than 2.4 grams per day. Reading food labels can help you monitor your sodium intake.
  • At least 30 minutes of aerobic activity (such as brisk walking, jogging, swimming, etc.) most days of the week (at least 4 out of 7 days).
  • Tobacco cessation (quit smoking). This can lower BP by 10 mmHg.
  • Limitation of alcohol intake to 2 drinks daily in men and 1 drink daily in women (1 drink is equivalent to 12 ounces of beer, 5 ounces of wine, or a small shot of liquor or hard drinks).
  • There is no need to eliminate caffeine. But do not take more than 2 cups per day. Avoid caffeine 30 minutes prior to taking your BP.

Top these off with stress reduction (“relax, mate”), and support from family and friends, and you can be sure to keep up with your BP.


DASH is an acronym that stands for Dietary Approaches to Stop Hypertension. This eating plan is meant to lower blood pressure through a low-fat, low-sodium, high-potassium diet, in as early as 2 weeks.

In this diet, you eat:

  • More fruits, vegetables, and low-fat dairy foods
  • More whole-grain foods, fish, poultry, and nuts
  • Less foods high in saturated fat, cholesterol, and trans fats
  • Less sodium, sweets, sugary drinks, and red meats.

What exactly should you eat per day? A lot, actually (you won’t go hungry). Every day, you can eat:

  • Grains: 7-8 daily servings
  • Vegetables: 4-5 daily servings
  • Fruits: 4-5 daily servings
  • Low-fat or fat-free dairy products: 2-3 daily servings
  • Meat, poultry, and fish: 2 or less daily servings
  • Nuts, seeds, and dry beans: 4-5 servings per week
  • Fats and oils: 2-3 daily servings
  • Sweets: try to limit to less than 5 servings per week

What is one serving?

Rice or pasta ½ cup
Bread 1 slice
Vegetables or fruits 1 cup raw or ½ cup cooked
Milk 8 ounces (1 cup)
Oil 1 tsp
Meats 3 ounces (size of a matchbox)


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