Q. Help! I hear that even small increases in blood pressure increase the risk of stroke. But I've also heard that for people 60 and older, the cutoff for high systolic blood pressure is now 150 not 140. What's up?
A. Yes, it is confusing, but it may not be quite as bad as you think.
Hypertension is still defined as a systolic blood pressure level of 140 or higher or a diastolic pressure of 90 or higher. (The systolic number is your blood pressure when your heart is contracting; the diastolic number is the pressure when your heart is at rest.) But controversial new guidelines from an expert panel known as the Eighth Joint National Committee recently recommended 150/90 as the threshold at which doctors should start prescribing blood-pressure lowering drugs to people age 60 and older. That advice conflicts with recommendations from the American Heart Association, which say that treatment—starting with lifestyle changes and then medication if necessary—should at 140/90 until age 80, then at 150/90.
Whose recommendations should you follow? Our experts err on the side of caution. “In general, blood pressures over 140/90 should raise red flags at any age, especially in the presence of common co-morbidities such as diabetes, and elevated cholesterol,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “And since heart attack and strokes likely bear a strong relationship, over time, to the height of the blood pressure, I tend to stress life style changes even for those with blood pressure levels that aren’t optimal, but are below the 140/90 cut off,” Lipman says.
A new analysis, published this week in the journal Neurology, supports that idea. It looked at about 762,400 adults, from 19 prior studies, and found that even small increases in blood pressure increased the risk of stroke. It found that people with blood pressure levels above 120/80 but below 140/90 were 66 percent more likely to have a stroke over about 8 years than people with optimal levels. To put that risk in perspective, the researchers told us that for every 1,000 people with optimal blood pressure, about 1.4 people per year will have a stroke. That compares with 2.8 strokes among people with blood pressure levels between 120/80 and 129/84, and 3.8 strokes among those with levels between 130/85 and 139/89.
Read more about how to lower blood pressure through lifestyle changes such as quitting smoking, cutting back on sodium, and losing excess weight. Drugs generally are needed only if you have levels over 140/90 and those changes haven’t helped, or if you also have diabetes, coronary heart disease, or kidney disease. Read more about blood-pressure medications in our Best Buy Drugs reports on ACE inhibitors, Beta Blockers, and Calcium Channel Blockers. And if you want to monitor your blood pressure at home, see our reviews and buying guide of blood pressure monitors.
—Doug Podolsky
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