By CINDY LADAGE

Illinois Corresponden

tSPRINGFIELD, Ill. — With the passage of the holidays and low market prices, the stress can raise a farmer’s blood pressure. In hoping for a healthy New Year, they may want to pay attention to new guidelines from the American College of Cardiology (ACC) and the American Heart Assoc. (AHA) about blood pressure and hypertension.

The guidelines state that high blood pressure should be treated earlier with lifestyle changes, and in some patients with medication – at 130/80 mm Hg, rather than 140/90.

This is the first revision since the previous guidelines (JNC7) came out in 2003. Dr. John Flack, chair and professor of Internal Medicine at Southern Illinois University School of Medicine, did two peer reviews on the guidelines prior to publication and said the changes mean now there are 103 million people in the United States with hypertension.

Before the guideline revisions, 32 percent of the public was diagnosed with hypertension. The new guidelines increased that number to 46 percent.

The new guidelines eliminated the pre-hypertension category that previously existed, and now there are two levels of hypertension: Elevated or Stage 1 (130-139 or 80-89 mm Hg); and Stage 2 (140/90 or higher).

The danger of high blood pressure is real. “This is the No. 1 reason people go to the doctor in an ambulatory clinical setting,” Flack said.

These days he said medical professionals of all practices, from optometrists to dentists, are checking their patients’ blood pressure. And with more health professionals taking measurements, the guidelines address the importance of having a proper technique to measure blood pressure.

To receive a good blood pressure measurement, Flack said, “The patient should rest for five minutes before the measure is taken. The arm should be at heart height and supported, with the legs uncrossed. The measurement should be obtained in a quiet room on the bare arm.”

While the guidelines label more people with hypertension, this does not mean that everyone with hypertension will be on medication. “In the past, everyone diagnosed with hypertension qualified for drug treatment right away,” Flack said. “Now, slightly fewer than one-third of Stage I hypertension will qualify for pharmacological treatment.”

The recommendation is only to prescribe medication for those with Stage 1 hypertension if the patient has already had a cardiovascular event such as a heart attack or stroke. Others who will automatically qualify for medical treatment at 130/80 mm Hg are those suffering from diabetes or chronic kidney disease, and those 65 years of age and older.

For those without these risks, the absolute cardiovascular risk over the next 10 years will be calculated. If they are at risk they will receive medication, and if not, they will be encouraged to make lifestyle changes and focus on ways to reduce their risk of hypertension.

“This will identify those with high risk for cardiovascular disease, and for those with a high risk, the benefits are greater,” Flack said about those receiving medication right away.

Along with lifestyle changes, he said the DASH diet can lower blood pressure levels. The DASH eating plan is a diet rich in fruits, vegetables and low-fat or nonfat dairy. It also includes mostly whole grains; lean meats, fish and poultry, nuts and beans. It is high fiber and low to moderate in fat.

It is a plan that follows federal guidelines for sodium content, along with vitamins and minerals. The DASH diet website states it was developed to lower blood pressure without medication in research sponsored by the National Institutes of Health. The first DASH diet research showed it could lower blood pressure, as well as first line blood pressure medications, even with a sodium intake of 3,300 mg a day.

“Since then,” the site at http://dashdiet.org added, “numerous studies have shown that the DASH diet reduces the risk of many diseases, including some kinds of cancer, stroke, heart disease, heart failure, kidney stones and diabetes. It has been proven to be an effective way to lose weight and become healthier at the same time.”

Flack also said a number of people who were considered “in control” of their hypertension before, under prior guidelines, will not be “in control” under the new guidelines and will may require intensification of their treatment.

There are multiple medications that work well for hypertension and thankfully, many of these are not too expensive. “Patients have access to a big swath of highly effective drugs,” Flack said.

Besides medications, he said there are some new therapies that are not yet approved, but look promising for treating hypertension.