As we recently reported, there has been progress in tackling heart disease mortality in the US, though it remains one of the main causes of death around the country and the world, and some aspects of heart disease, including high blood pressure, appear to be on the rise. Your risk of having high blood pressure increases as you get older, due to factors including genetics, race, weight, insufficient physical activity, diet, and other lifestyle factors. For a while, there has been some question as to how aggressively high blood pressure really needs to be treated in the “old old” population (i.e., those over 80), but new research published in The Journal of the American College of Cardiology found that even in this older population, intensive blood pressure management may be valuable and offer important benefits, though there is always the need to balance the risks of such treatment given side effects and personal preferences. For more on this study, read here.

There is no dispute, however, that treatment for high blood pressure in those under 80 is essential- and new guidelines jointly issued by the American Heart Association and the American College of Cardiology underscore the importance of treating high blood pressure, even among those who do not consider themselves to have serious blood pressure problems. It has been estimated that nearly ½ of all US adults have at least stage 1 hypertension blood pressure (meaning ≥130/80 mm Hg). Since high blood pressure is the most preventable risk factor for cardiovascular disease, and has also now been strongly implicated in other health risks, including cognitive decline, dementia, and kidney disease, it’s essential to both try to prevent it and to aggressively treat it once discovered. The new guidelines focus on several important aspects of high blood pressure prevention and treatment: Anyone can develop high blood pressure, and everyone should be aware of their blood pressure readings. Lifestyle factors are essential for getting high blood pressure under control, and medications must be considered if blood pressure does not come down despite changes to physical activity, diet, stress, weight control, and other lifestyle factors. In fact, the new guidelines suggest that more Americans should be on blood pressure medications and that clinicians should aim for earlier intervention than they previously advised. For anyone with a blood pressure of ≥130/80 mm Hg, the guidelines recommend 3-6 months of lifestyle changes to see if that number goes down, and if not, medications to lower blood pressure should probably be started. It also suggests that clinicians use the PREVENTION risk calculator to determine a patient’s 10-year risk of cardiovascular disease. In essence, this push to consider medications for those in Stage 1 of high blood pressure is one of the biggest changes of these new recommendations.

Other changes from the previous recommendations (that date from 2017) include more emphasis on lifestyle factors, including reducing salt intake, cutting back or even totally abstaining from alcohol, managing stress, maintaining a healthy weight, or if overweight or obese, aiming for a 5% weight loss (which could include the use of a GLP-1 or surgery), healthy eating, exercise and home blood pressure monitoring. So start strategizing about healthier lifestyle behaviors and find out more about the new blood pressure recommendations here.

Speaking of blood pressure monitoring, there is new research that suggests many blood pressure readings may be inaccurate, even to the point where patients who should be on medications are misdiagnosed and thus under the impression they do not have a problem. According to this research, undertaken by the University of Cambridge, blood pressure monitoring arm cuffs may cause systolic blood pressure (the upper number) to be underestimated by as many as 6 points, and thus, at least 30% of patients who would otherwise be eligible for treatment under the new guidelines are not given accurate information about their readings. A typical arm cuff doesn’t squeeze the arm evenly along its length, so the reading that results may not be accurate. There are ways to redesign the cuff- or even have the patient raise her arm before a reading- to compensate for this problem. For more on this research, look here. Nonetheless, blood pressure measurements at home are important to understanding your level of illness and to determine if lifestyle changes or medications are having any effect. Finally, for some suggestions about what to look for when purchasing a home monitor, take a look here at suggestions from Better Health While Aging, including a list of questions to ask your doctor about blood pressure monitoring (it’s also recommended you bring your home monitor to your doctor’s office to compare readings with the professional monitor).