New Hypertension GuidelinesMarch 2018
By William Faloon
Life Extension® has waged a long battle over what defines optimal blood pressure.
Back in the early 1980s, doctors delayed treatment until systolic blood pressure exceeded 150 mmHg.
We argued against allowing patients to have blood pressure this high. Our readers were urged to target their blood pressure below 120/80 mmHg.
Against us was a medical establishment that viewed systolic blood pressure of 140-150 mmHg as “normal.” They viewed it as “normal” because most elderly people were in these high ranges.
Our rebuttal was that it is also “normal” for older people to succumb to heart attack, stroke and kidney failure related to higher-than-optimal blood pressure.
On November 13, 2017, at the American Heart Association’s annual conference, revised hypertension guidelines were issued. The new guideline specifies that normal systolic pressure is under 120 mmHg.
We applaud this turnabout, but regret it took over 30 years for this common-sense approach to be recognized. The cost in shortened lifetimes caused by the establishment’s delay in recognizing optimal blood pressure is enormous.
This editorial clarifies these new hypertension guidelines and suggests how to better lower your blood pressure.
As you can see by the chart at the bottom of this page, the majority of Americans aged 65 and older have high blood pressure that is medically defined as hypertension.
With the new hypertension guidelines from the American Heart Association and the American College of Cardiology, an even greater number of Americans are now clinically hypertensive. This will enable more people to take assertive actions to achieve lower blood pressure and reduce their risks of losing their eyesight, suffering kidney failure, and developing coronary-cerebral artery occlusion.
It’s important to note that the study the American Heart Association and the American College of Cardiology most relied on to revise blood pressure guidelines downward involved people at risk for cardiovascular disease.1 Some argue these findings may not apply to individuals at low risk.
I continue to urge that healthy individuals of all ages strive for low-normal blood pressure readings. I say this based on a volume of observational studies, including data showing that people who have mid-life hypertension are at higher risk of vascular events even when they lower their blood pressure in later life.2-5
Arterial damage is most severe when blood pressure peaks. You don’t get credit for the hours when blood pressure is in low normal ranges. This is why at-home monitoring of blood pressure at different times of the day is so important.
The charts you see on these pages are from the many Power Point presentations I have given suggesting most people target their blood pressure around Life Extension’s optimal range of 115/75 mmHg.
Another purpose of this editorial is to provide guidance to help ensure that elderly readers do not lower their blood pressure too quickly, as this can create adverse consequences.
Early Data Showed Benefits of Lower Blood Pressure
In year 2013, a published analysis of 18 prior studies showed that people whose systolic blood pressure was in the range of 120-139 mmHg were at a 50% increased risk of coronary heart disease and 71% increased risk of stroke.7
The studies analyzed in this 2013 report are among those that Life Extension used long ago to recommend that optimal systolic blood pressure for most individuals is around 115 mmHg.
Mainstream medicine during this pre-2017 era did not classify people with systolic readings of 120-139 mmHg as hypertensive. The tragic results, based on observational studies, are many preventable heart attacks, strokes, and other degenerative conditions that can occur when systolic pressure exceeds 119 mmHg.8-10
The systolic number is most important as this reflects the pressure applied to the arterial system with each heartbeat. Higher arterial pressure causes greater damage to the endothelium, renal tubules, and delicate structures in the eye.
The Study That Woke Up the Medical Establishment!
The studies compiled for publication in 2013 were not enough for establishment cardiology to pay attention. They wanted to see hard data from a carefully controlled clinical trial.
The sought-after trial was initiated in 2010 with a large group of people. The purpose was to assess whether targeting a reduction of systolic blood pressure below 120 mmHg was superior to the then-current standard of reducing it to below 140 mmHg.
The doctors focused on the systolic (top) number because it is a better predictor of heart attack and stroke.
The name of this study is Systolic Blood Pressure Intervention Trial, also known as SPRINT.11 It was published in the New England Journal of Medicine in 2015 and garnered huge media coverage.
The SPRINT study was supposed to last five years, but was stopped after 3.26 years because it was abundantly clear that the group whose blood pressure was reduced to a target systolic range under 120 mmHg were dying 27% less frequently.
What impressed the study’s researchers the most was a striking 43% lower relative risk of cardiovascular death in those whose blood pressure was aggressively reduced.11
The SPRINT study also found that heart failure rates plummeted by 38% in patients whose target blood pressure aimed below 120 mmHg. Heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in one’s body. It is a leading cause of hospitalizations and costs this nation an estimated $32 billion each year.12
Heart disease remains the number-one cause of death in the United States, killing about 610,000 Americans each year.13
The dramatic (43%) drop in cardiovascular deaths shown in the SPRINT study motivated mainstream cardiologists to question their long-standing practice of largely ignoring their patient’s blood pressure until readings exceeded 139/89 mmHg.
Based on widespread media coverage and physician concurrence, it appears the medical establishment has finally woken up to what readers of this publication were told to do in the 1980s.
Safety Concerns When Blood Pressure is Lowered too Much
Older individuals face a dilemma when it comes to rapid blood-pressure reduction.
Decades of systolic blood pressure above 115 mmHg, along with risk factors in the blood such as C-reactive protein, homocysteine and triglycerides can damage the delicate endothelium that lines the inner arterial wall.
As a result of prior arterial injury, some older people need to maintain higher-than-optimal blood pressure to ensure their kidneys are sufficiently removing waste products, and that their brain is receiving sufficient oxygen flow.
In the SPRINT study that convinced the American Heart Association and the American College of Cardiology to adopt lower systolic guidelines (below 120 mmHg), there was an increase in the risk of kidney problems.
Practical Steps to Blood-Pressure Control
I continue to be shocked by antiquated recommendations made by organizations like the American Heart Association.
In revising their definition of optimal systolic pressure to below 120 mmHg, the American Heart Association suggests people have their blood pressure tested once every two years at their doctor’s office.18
This suggestion makes no sense considering that low-cost at-home monitors are widely available and are proven to enable superior 24-hour blood-pressure control.
There is extensive individual variability in patient responses to blood-pressure lowering therapies. Some people need twice-a-day drug dosing, or only need to take their medications in situations when their blood pressure elevates (such as when drinking caffeine or under stressful events or during particular times of the day/night).
I have vociferously argued for decades that systolic blood pressure should be below 120 mmHg. I am equally confident that most readers of this magazine can better control their blood pressure using an at-home monitor. This enables precise control of drug dosing and offers the ability to measure the effects of lifestyle changes like losing weight, healthier diets and getting more physical activity.
Blood Tests Measure Kidney Function
For those who now seek to aggressively drop their systolic reading to below 120 mmHg, we urge this be done slowly, using an at-home monitor to carefully control the rate of blood-pressure reduction.
As blood-pressure readings drop, check your blood markers of kidney function using low-cost blood tests that measure creatinine, blood urea nitrogen (BUN), glomerular filtration rate and lots more. Blood test panels that include these measures of renal function cost very little.
If blood-test results indicate a kidney problem, cut back on your blood pressure reduction program, consult your physician and retest within two weeks.
The most accurate measure of renal health is the cystatin-c blood test. This costs more than standard CBC/Chemistry blood tests, but for those at risk for renal complications, we have long advocated its use.
These blood tests can be ordered 24 hours/day by calling 1-800-208-3444 or logging on to LifeExtension.com/labtesting
Protecting the Brain against Reduced Oxygen Flow
Aggressive blood pressure reduction can create problems for certain elderly, frail people.
Older patients with significant pre-existing vascular disease and other medical problems often require higher blood pressure to perfuse critical organs like the brain.
These patients require a higher perfusion pressure to allow blood to reach critical organs and tissues throughout the body.19
We described the phenomenon in previous issues of Life Extension Magazine®,20 whereby some older patients do not tolerate aggressive blood pressure reduction to a predefined value (such as under 120 mmHg).
These individuals require careful monitoring using blood tests as well as assessments of cognitive function.
These tests are necessary to facilitate appropriate dosing of antihypertensive medications to a blood pressure that can be tolerated by these patients.
When lowering one’s blood pressure, one should be cognizant of dizzy spells, memory lapses, and perceived loss of motor coordination (frailty).
Ideally, one would have clinical measures performed using a standardized frailty index score, but this is not available from most physicians.
Nutrients most readers of this magazine take, along with healthy diets containing plant-based polyphenols, can protect and help restore cerebral circulation.21-23
Those embarking on an aggressive blood-pressure reduction program may also consider a periwinkle-derived alkaloid called vinpocetine that has been used for decades in Europe by those with chronic cerebral hypoperfusion.24-26
Blood-Flow-Restoring Effects of Vinpocetine
Cerebral ischemia (loss of blood flow) can lead to irreversible brain damage. It is therefore important to rescue hypoperfused areas of the brain whenever possible.
A review was conducted on the effects of vinpocetine on chronic cerebrovascular patients.25 Studies included cerebral perfusion imaging and clinical assessments of cognitive function after single dose and long-term vinpocetine use.
The results from these clinical trials showed that vinpocetine increased cerebral perfusion,26 elevated brain-cell consumption of glucose-oxygen,26,27and improved other measures of neurological function.28
This analysis showed that vinpocetine improves blood flow to hypoperfused areas of the brain and enhanced quality-of-life scores.25
Those seeking to avoid depriving their brain of blood flow when lowering their blood pressure may consider supplementing with 20-30 mg daily of low-cost vinpocetine.
Nutrients Versus Drugs
There are a wide variety of nutrients that produce modest blood pressure-lowering effects.
If your systolic pressure is around 125 mmHg and you seek to bring it down to the 115 mmHg range, you might be able to accomplish this by losing a little weight, improving your diet, exercising more, and supplementing with quercetin and melatonin.
For many people, however, they will need the appropriate prescription medication to achieve optimal blood-pressure goals. The long history of use with these drugs and their low cost causes us to recommend certain drugs that not only safely lower blood pressure, but confer other benefits such as improving endothelial function.
In the March 2015 issue of Life Extension Magazine, we published a report on a generic drug called telmisartan that we felt was the best antihypertensive drug for most individuals to consider.29
With the availability of low-cost at-home blood-pressure monitors, there is no longer a need to speculate as to what approach one should take.
If lifestyle changes and/or nutrients enable one to achieve optimal readings (115/75 mmHg), then prescription drugs are obviously not needed for blood-pressure control.
If systolic pressure remains persistently above 119 mmHg, then 40 mg a day of telmisartan (and/or other medications your physician prescribes) should be attempted. Telmisartan doses can be increased to 80 mg/day if needed.
Unlike many drugs the FDA approves that are side-effect prone and don’t work particularly well, certain antihypertensive medications have lifesaving properties that cannot be overlooked if one’s blood-pressure readings remain higher than optimal.
The Turning Tide of Medical Opinion
Fascinating reviews about the history of hypertension can easily by obtained via Google searches.
As recently as 1949, an esteemed physician published that systolic blood pressure over 200 mmHg need not be treated.30
In the 1980s, many doctors accepted systolic readings of 160 mmHg as normal and did not treat it.31
The revised 2017 guidelines that normal systolic pressure is under 120 mmHg will spare many humans from disability and death.
An abundance of published findings confirms that keeping one’s blood pressure on the low end of the reference range confers significant protection against a host of degenerative conditions.
The easiest way to accomplish this is with an at-home blood-pressure monitor. This enables you to assess your blood pressure at several different times of the day to ensure there are no significant elevations above 119 mmHg.
The box on this page is a description of a recent study showing vastly superior results when people check their blood pressure at home, rather than waiting for their next doctor’s visit.
For longer life,
William Faloon, Co-Founder
Life Extension Buyers Club
- Available at: http://www.ajmc.com/conferences/aha-2017/80-new-guidelines-say. Accessed December 13, 2017.
- Gottesman RF, Albert MS, Alonso A, et al. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017;74(10):1246-54.
- Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017;89(18):1886-93.
- Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and dementia - a comprehensive review. Ther Adv Neurol Disord. 2009;2(4):241-60.
- Allen N, Berry JD, Ning H, et al. Impact of blood pressure and blood pressure change during middle age on the remaining lifetime risk for cardiovascular disease: the cardiovascular lifetime risk pooling project. Circulation. 2012;125(1):37-44.
- Available at: https://www.cdc.gov/nchs/fastats/older-american-health.htm. Accessed December 15, 2017.
- Huang Y, Wang S, Cai X, et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med. 2013;11:177.
- Kshirsagar AV, Carpenter M, Bang H, et al. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119(2):133-41.
- Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52.
- Taylor BC, Wilt TJ, Welch HG. Impact of diastolic and systolic blood pressure on mortality: implications for the definition of “normal”. J Gen Intern Med. 2011;26(7):685-90.
- Sprint Research Group, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-16.
- Huynh-Hohnbaum AL, Marshall L, Villa VM, et al. Self-Management of Heart Disease in Older Adults. Home Health Care Serv Q. 2015;34(3-4):159-72.
- Available at: http://www.cdc.gov/heartdisease/facts.htm. Accessed August 22, 2016.
- Myers MG, Cloutier L, Gelfer M, et al. Blood Pressure Measurement in the Post-SPRINT Era. A Canadian Perspective. 2016;68(1):e1-e3.
- Niiranen TJ, Kantola IM, Vesalainen R, et al. A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment. Am J Hypertens. 2006;19(5):468-74.
- Fagard RH, Van Den Broeke C, De Cort P. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens. 2005;19(10):801-7.
- Agarwal R, Andersen MJ. Blood pressure recordings within and outside the clinic and cardiovascular events in chronic kidney disease. Am J Nephrol. 2006;26(5):503-10.
- Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/How-High-Blood-Pressure-is-Diagnosed_UCM_301873_Article.jsp. Accessed December 18, 2017.
- Stocchetti N, Chieregato A, De Marchi M, et al. High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions. Acta Neurochir Suppl. 1998;71:162-5.
- Available at: http://www.lifeextension.com/Magazine/2016/11/Why-24-Hour-Blood-Pressure-Control-Matters/Page-01. Accessed December 18, 2017.
- Vauzour D. Dietary polyphenols as modulators of brain functions: biological actions and molecular mechanisms underpinning their beneficial effects. Oxid Med Cell Longev. 2012;2012:914273.
- . Kennedy DO. Polyphenols and the human brain: plant “secondary metabolite” ecologic roles and endogenous signaling functions drive benefits. Adv Nutr. 2014;5(5):515-33.
- Bowtell JL, Aboo-Bakkar Z, Conway ME, et al. Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Appl Physiol Nutr Metab. 2017;42(7):773-9.
- Horvath S. [The use of vinpocetine in chronic disorders caused by cerebral hypoperfusion]. Orv Hetil. 2001;142(8): 383-9.
- Bagoly E, Feher G, Szapary L. [The role of vinpocetine in the treatment of cerebrovascular diseases based in human studies]. Orv Hetil. 2007;148(29):1353-8.
- Bonoczk P, Panczel G, Nagy Z. Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study. Eur J Ultrasound. 2002;15(1-2):85-91.
- Szilagyi G, Nagy Z, Balkay L, et al. Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study. J Neurol Sci. 2005;229-230:275-84.
- Balestreri R, Fontana L, Astengo F. A double-blind placebo controlled evaluation of the safety and efficacy of vinpocetine in the treatment of patients with chronic vascular senile cerebral dysfunction. J Am Geriatr Soc. 1987;35(5):425-30.
- Available at: http://www.lifeextension.com/Magazine/2015/3/Best-Drug-To-Treat-Hypertension/Page-01. Accessed December 18, 2017.
- Moser M. Historical perspectives on the management of hypertension. J Clin Hypertens (Greenwich). 2006;8(8 Suppl 2):15-20; quiz 39.
- The 1980 report of the joint national committee on detection, evaluation, and treatment of high blood pressure. Archives of Internal Medicine. 1980;140(10):1280-5.
- Krakoff LR. Blood Pressure Out of the Office: Its Time Has Finally Come. Am J Hypertens. 2016;29(3):289-95.
- Fuchs SC, Ferreira-da-Silva AL, Moreira LB, et al. Efficacy of isolated home blood pressure monitoring for blood pressure control: randomized controlled trial with ambulatory blood pressure monitoring - MONITOR study. J Hypertens. 2012;30(1):75-80.
- Breaux-Shropshire TL, Judd E, Vucovich LA, et al. Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes. Integr Blood Press Control. 2015;8:43-9.
- Agena F, Prado Edos S, Souza PS, et al. Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP. Nephrol Dial Transplant. 2011;26(11):3745-9.
- Imai Y, Obara T, Asamaya K, et al. The reason why home blood pressure measurements are preferred over clinic or ambulatory blood pressure in Japan. Hypertens Res. 2013;36(8):661-72.
- Fuchs SC, Mello RG, Fuchs FC. Home blood pressure monitoring is better predictor of cardiovascular disease and target organ damage than office blood pressure: a systematic review and meta-analysis. Curr Cardiol Rep. 2013;15(11):413.