Dr. Sam Goldhaber discusses the newest development in hypertension guidelines.

Hello, I’m Dr. Sam Goldhaber. I’m President of NATF, and you are tuned into the Clot Chronicles.

Today, I’m going to speak about high blood pressure, hypertension, which is a problem that afflicts many tens of millions of Americans throughout the United States. We have great medications to treat high blood pressure and we know, of course, the first treatment is a heart healthy lifestyle with good nutrition and daily exercise.

The American Heart Association recommends that each of us have at least thirty minutes a day of exercise, which could be walking, for at least six days per week, but often good exercise and good nutrition are not enough to lower the blood pressure to safe levels and then we need to use medications as well. We have many different classes of medications.

It is uncertain what the target blood pressure should be. It used to be 140/90 mmHg. More recently, 130/80 mmHg has become the standard, but even more recently one large trial from the Veteran’s Administration suggested that the new standard should be 120/80 mmHg. But, despite these varying targets, many patients require two or three blood pressure reduction medications and, of course, high blood pressure usually is not symptomatic and so medication adherence becomes a challenge. I think we’re going to see over the future, a more robust attempt to get the blood pressures in the target range of 120–130/80 mmHg.

Also, we have to keep in mind that the blood pressures vary quite a bit during the day so when a patient comes to a doctor’s office, often running into traffic along the way and having some challenges finding a good parking space, naturally the blood pressure is going to be elevated. The new way that we assess an accurate blood pressure and whether we need more blood pressure reduction medication is to do a twenty-four hour blood pressure monitoring. We put the cuff on the arm for twenty-four hours and the cuff automatically takes the blood pressure about three or four times per hour, even while one is sleeping. That information is fed into a microcomputer that’s embedded in this special blood pressure cuff and then the data are analyzed after the blood pressure cuff is returned and we get an average blood pressure and heart rate of that twenty-four hour period. So, I think we’ll see more twenty-four hour blood pressure monitoring and more medication prescribed with a renewed attempt to get America into a normal blood pressure range.

This is Dr. Sam Goldhaber signing off for the Clot Chronicles.