By the age of 40, over half of Americans are grappling with high blood pressure, often without realizing it. Known as the ‘silent killer,’ hypertension poses serious health risks if left untreated, making it crucial for individuals to be vigilant about their blood pressure levels. The absence of symptoms means many remain unaware of the increasing pressure in their blood vessels.
Recent recommendations from the American Heart Association advocate for early intervention, suggesting that individuals should begin lifestyle modifications and consider medication if systolic blood pressure exceeds 130/80 mm Hg. This standard refers to the measurement of pressure in millimeters of mercury, an important metric in health assessments. Medical experts emphasize that acting quickly can significantly enhance long-term health outcomes.
Hypertension is a major contributor to heart disease, which remains the leading cause of death for both men and women in the United States. Additionally, high blood pressure heightens the risk of kidney disease and cognitive decline, including dementia. Research has indicated that damage to small blood vessels in the brain, linked to hypertension, can adversely affect cognitive function.
Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania, highlights the preventive potential of treating hypertension earlier. She notes that millions of American adults could benefit significantly from lifestyle adjustments and medication.
“If you catch it early, and treat it early, you can end up with many more years of healthy life expectancy,” Cohen confirms. This proactive approach can lower the risks of heart attacks, strokes, kidney damage, and dementia.
The guidelines reinforce long-standing advice about maintaining a low-sodium diet, although this can be quite challenging considering that a large portion of dietary calories in the U.S. comes from ultra-processed foods that typically contain high levels of salt.
The new recommendations also emphasize the importance of lifestyle changes, including regular exercise, reduced alcohol consumption, and stress management techniques such as meditation, yoga, or deep breathing exercises. For individuals with systolic blood pressure in the 130s, the focus should start on dietary and lifestyle changes, progressing to medication if blood pressure fails to improve.
In cases where systolic blood pressure hits 140 or higher, classified as Stage 2 hypertension, clinical evidence suggests immediate benefits from high blood pressure medications. Dr. Dan Jones, chair of the guideline writing committee at the Heart Association, stated, “For all people with a blood pressure over 140/90 mm Hg, we recommend beginning with two medications.” He explains that one medication is often insufficient to bring blood pressure down to the desired level.
Despite being aware of their hypertension, over half of affected individuals struggle to achieve a normal blood pressure of 120/80 mm Hg or lower. Challenges such as medication side effects, variations in individual responsiveness to treatment, and a reluctance to adopt pharmacological interventions can hinder effective management. Moreover, making lifestyle changes can present significant daily challenges.
Health care professionals commonly utilize a risk calculator to personalize treatment plans based on individual risk factors for heart disease.
The story of George Solomon, a former law enforcement officer, illustrates the impact of hypertension and the importance of proactive management. Initially hesitant to take medication due to feeling fine, Solomon experienced a life-altering stroke at age 63.
After retiring, he had embraced a new lifestyle, incorporating regular exercise and hobbies like splitting wood on his farm. However, in the spring of 2023, he suddenly felt unwell.
Recalling that day, Solomon described how he couldn’t get back up after sitting down, experiencing a strange sensation across his back and loss of feeling in his arm and leg. An ambulance transported him to Duke University Hospital, where he underwent treatment and rehabilitation for his stroke.
Now approximately 80% recovered, he acknowledges the essential role of healthy habits and medications in preventing future strokes. “I feel I’m on the right path,” he claims, having lost weight and increased both cardio and strength training activities. Solomon shares his experience with the hope that it serves as a wake-up call for others to take action regarding their health.
In the pharmacological realm, several types of medications are available for hypertension management. These include diuretics that facilitate the removal of excess salt and water, ACE inhibitors that interfere with the production of angiotensin II (a hormone contributing to blood vessel constriction), and calcium channel blockers that help reduce blood pressure by limiting calcium entry into cells.
Despite existing treatments, many individuals with hypertension do not achieve adequate blood pressure control. According to Cohen, there is growing interest in a new class of medications targeting the hormone aldosterone, which is instrumental in regulating fluid and sodium levels in the body. Excess aldosterone is a significant contributor to high blood pressure. Although this innovative drug is not yet available on the market, recent research findings may pave the way for a new treatment option.
A study featured in the New England Journal of Medicine identified a promising aldosterone-blocking drug, baxdrostat, as effective in lowering blood pressure among individuals struggling to control their hypertension, even while on two or three medications.
Dr. Jennifer Brown, a cardiologist at Brigham and Women’s Hospital and a key researcher behind the study, explained that after a 12-week treatment period, participants receiving baxdrostat experienced about a 10-point blood pressure reduction compared to those on a placebo. Sponsored by AstraZeneca, this study aims to share its results with regulatory authorities by the end of the year, potentially leading to a new avenue of hypertension treatment.
image source from：npr
