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The American Heart Association just released new guidelines for blood pressure management.
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The organization looks at several areas of health to address blood pressure.
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Doctors stress the importance of lifestyle changes.
High blood pressure is linked to a higher risk of developing a slew of health complications you want to avoid, including heart attack, stroke, and dementia. But nearly half of American adults have high blood pressure. So, the American Heart Association (AHA) released new guidance on how to prevent high blood pressure, as well as how it should be detected, evaluated, and managed. These guidelines are the first update since 2017, making them a big deal.
Meet the experts: Ragavendra Baliga, M.B.B.S., a cardiologist at The Ohio State University Wexner Medical Center; Shaline Rao, M.D., a cardiologist at NYU Langone; Varinder Singh, M.D., chairman of cardiology at Northwell’s Lenox Hill Hospital; Jennifer Wong, M.D., cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA
While these guidelines can get a little technical, the AHA has very clear information on what people can do to lower their risk of high blood pressure (a.k.a. hypertension), including making some unsuspecting lifestyle changes. Here’s what’s in the new guidelines, plus what cardiologists want you to keep in mind.
What do the new guidelines say?
The new guidelines cover nearly everything blood pressure-related, meaning it’s a lot to wade through. But there are a few key elements to keep in mind.
While blood pressure categories have stayed the same—the AHA says that a goal blood pressure remains at 120/80 mm Hg or lower—there’s a big emphasis on the importance of lifestyle factors to lower the risk of high blood pressure. It also notes that some people may need multiple medications to lower their blood pressure, including GLP-1 receptor agonist medications like Ozempic and Wegovy for patients who have overweight or obesity.
The guidance “empowers patients with practical tools that can support their individual health needs as they manage their blood pressure, whether through lifestyle changes, medications or both,” Daniel W. Jones, M.D., dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, and chair of the guideline-writing committee said in a statement.
How to lower your blood pressure, according to the AHA
The AHA shared some very clear advice on what to do to lower your blood pressure. Here’s what the organization recommends.
Take a pass on alcohol
While the AHA is careful not to say that you shouldn’t drink at all, it definitely suggests that avoiding alcohol can be helpful for blood pressure. “This is a shift in the guidelines,” says Shaline Rao, M.D., a cardiologist at NYU Langone. “Over the years there had been differing views on alcohol and potential cardiovascular risk, ranging from light benefit to harm. We have seen in different avenues that consistent alcohol intake has more potential for risk than benefit.”
So, why might reducing alcohol help? “While many people note that alcohol may cause blood pressure to drop early on due to relaxation of blood vessels, as the liver metabolizes the alcohol, we see the blood vessels constrict,” Dr. Rao explains. “Higher level alcohol intake can cause this cycle to repeat and result in increased stiffness in the blood vessel walls. This has the downstream impact of higher blood pressure over time.”
If you choose to drink, the AHA recommends having no more than two drinks per day for men and no more than one drink per day for women.
Despite what the AHA says, cardiologists consistently say that it’s best not to drink. “Alcohol is a carcinogen,” says Varinder Singh, M.D., chairman of cardiology at Northwell’s Lenox Hill Hospital. “I tell my patients that if they don’t drink, keep it that way. If you do drink, be very mindful of how much you have.”
Dr. Wong agrees. “It’s best not to drink any alcohol at all,” she says. “If you’re going to drink, the AHA’s guidelines should be the absolute highest amount you have.” While the AHA has its guidelines, Dr. Singh suggests that his patients have no more than one ounce a day of any form of alcohol.
Limit your sodium intake
Less than 2,300 milligrams per day is the goal, with an ideal limit of 1,500 milligrams per day by checking food labels. Sodium can cause something known as vasoconstriction, which is the narrowing of the blood vessels, points out Jennifer Wong, M.D., a cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA. When your blood vessels narrow, your blood pressure goes up.
Not only can sodium cause vasoconstriction, it may also reduce the effectiveness of diuretics, which are a type of medication that is used to lower blood pressure, Dr. Wong points out. So, lowering the amount of sodium you take in may support your blood pressure health on a few fronts.
“The goal isn’t zero sodium but to make healthy choices in your diet to avoid higher salt loads,” Dr. Rao says. “Common pitfalls are premade soups, processed meats and cheeses, and snack foods like chips. Taking note of food labels and being intentional in your use of salt when cooking can be very helpful to change blood pressure through lifestyle modification.”
Try to manage stress
The AHA specifically talks about managing stress with exercise, along with stress-reduction techniques like meditation, breathing control, or yoga.
“We’re starting to look at all of the different, holistic impacts on blood pressure in our lives, and one of those factors is stress,” Dr. Singh says. Stress causes the release of the hormone norepinephrine, which increases blood pressure, he points out. “If you’re consistently at a high stress rate, this can have a [damaging] effect on your health,” Dr. Singh says.
Work toward a healthy weight
If you have overweight or obesity, the AHA recommends trying to do at least a 5% reduction in your body weight—but speak with your healthcare provider for a more tailored recommendation if you believe you may fit the criteria. “If you’re carrying too much weight, it’s a stress on your body,” Dr. Singh explains. “It takes more work to climb up a hill and even to walk on a flat surface. Your blood pressure has to go up in response.”
Follow a heart-healthy eating pattern
The AHA specifically flags the DASH eating plan, which recommends lowering your sodium intake and eating a lot of vegetables, fruits, whole grains, legumes, nuts, and seeds, and low-fat or nonfat dairy, along with lean meats and poultry, fish, and non-tropical oils.
The emphasis on fruits and vegetables is important, according to Ragavendra Baliga, M.B.B.S., a cardiologist at The Ohio State University Wexner Medical Center. “They are rich in potassium, magnesium, and fiber, which counteract sodium’s effects, relax vascular tone, and reduce blood pressure,” he says.
Be physically active
Focus on getting at least 75 to 150 minutes each week of exercise, including aerobic exercise and/or resistance training, per the AHA.
Exercise improves your physical and mental health, Dr. Singh points out. “From a physical standpoint, it regulates your vascular tone—your arteries become more relaxed and contractable,” he says. That can help to lower your blood pressure, Dr. Singh explains.
But exercise can also have a positive impact on your mental health, lowering your levels of stress, which can also support your blood pressure.
Monitor your blood pressure at home
If you have a confirmed diagnosis of high blood pressure, checking your numbers at home can be helpful, according to the AHA. Incorporate checking your BP with an at-home blood pressure monitor into your routine.
The bottom line
If you have high blood pressure, Dr. Rao says that you can make all of these lifestyle changes and still may need to take medication. “For some people, no matter how much they do with lifestyle, it may not be enough,” she says. “For those patients, we have to combine lifestyle factors with medication to ensure they do not sustain the long-term health risk of high blood pressure.”
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