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Tuesday, May 30, 2023

Updates to hypertension guidelines

By Veita Bland, M.D. / May 19, 2023

Blood pressure readings are most accurate when taken in places patients feel the most comfortable.

Cardiovascular disease (CVD) is the leading cause of death in the United States. It accounts for nearly one-quarter of all deaths in men and women. Hypertension-related CVD mortality is currently on the rise in the United States. There has been a major shift in the world of hypertension, also called high blood pressure.

The numbers that we consider as indicators of hypertension have changed. So, why would that be?

According to Dr. Shawna Nesbitt, professor of internal medicine at the University of Southwestern Medical Center and the medical director of Parkland Hypertension Clinic in Dallas, Texas, the epidemic in obesity and being overweight are critical contributors to the high prevalence of hypertension. The new laboratory numbers/determinants of hypertension will cast a wider net around the people that we will treat. These new values will also mean there will be a wider gap in the prevalence of hypertension between men and women, and between Black and White people.

Dr. Nesbitt further states that hypertension-related CVD mortality is much higher in Black Americans than in White Americans with hypertension control rates being the lowest in Black, Hispanic and Asian males.

So, what are these new numbers/ determinants that the world of hypertension is all excited and concerned about? Previously in the 2017 recommendations, a blood pressure of 130/80 was considered elevated with 140/90 being stage 1 hypertension. In the new, more comprehensive and improved reclassification of the recommendations, 130/80 is now considered hypertension or stage 1. This is certainly a more aggressive stand that I am glad to see, and I believe this will save many patients from heart disease and the risk and sequel of CVD.

This change has again reemphasized the need for accurate blood pressure taking measures. It is important to allow patients to enter a room and sit for five minutes before their blood pressure. It is even more imperative that initiatives are in place to empower patients to be able to take their blood pressure readings at home. Blood pressure readings are most accurate when taken in places patients feel the most comfortable. That place is usually at home. Home is the place you spend the most time and thus the place where blood pressure numbers are most accurate and important.

The caveat of this though would include obtaining accurate equipment and the proper training to take blood pressures. Insurance companies would do well to invest in high quality, accurate blood pressure measurers for the homes of these patients.

Dr. Nesbitt also reminds us that patients must be aware of what may trigger elevations in their blood pressure such as fattening, difficult to digest foods or intense physical activity. The American Heart Association (AHA) reminds everyone of the need for a healthy diet, a healthy weight, adequate sleep, participating in physical activity, avoiding nicotine, and knowing your cholesterol and sugar levels in the fight for control of blood pressure or hypertension. All of these factors are part of the AHA’s new initiative in emphasizing the Essential 8 guidelines for healthy life.

Dr. Veita Bland is a board-certified Greensboro physician and hypertension specialist. Dr. Bland’s radio show, “It’s a Matter of Your Health,” can be heard live on Wednesdays, 5:30 p.m. on N.C. A&T State University’s WNAA, 90.1 FM. Listeners may call in and ask questions. The show is replayed on Sirius 142 at 5 p.m. on Wed. Email Dr. Bland at


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