Recently the American Heart Association updated their blood pressure guidelines with five categories. Knowing which category your numbers fall in can help you take the necessary steps to keep it under control.
Hafeza Shaikh, DO shares the five blood pressure categories and why it's important to know your numbers in order to live a healthier lifestyle.
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Updated Blood Pressure Guidelines
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Learn more about Hafeza Shaikh, DO
Hafeza Shaikh, DO
Hafeza Shaikh, DO is the latest addition to the cardiology team at South Jersey Heart Group, an affiliate of Lourdes Cardiology Services-a leader in cardiac care for southern New Jersey and the Delaware Valley.Learn more about Hafeza Shaikh, DO
Transcription:
Melanie Cole (Host): Understanding your blood pressure numbers is key to controlling high blood pressure and there’s new, updated guidelines recently changed and here to talk about those with us is Dr. Hafeza Shaikh. She’s a cardiologist with Lourdes Health System. Dr. Shaikh, so give us a little physiology lesson. What is blood pressure? Because people don’t even really understand what it is or the importance of it.
Hafeza Shaikh, DO (Guest): Sure. Well thank you first of all, for having me on this morning. It’s a pleasure to speak with you about this super important topic. So, in terms of high blood pressure, what it really means is within our arteries and veins, our fluid, our blood system is responsible for being at a certain pressure to make sure that all the organs in our body are getting the proper circulation that they should be getting. Unfortunately, though for especially a large sized population in the United States, a lot of us have the condition where that tension and that pressure is too high. And too high in this situation is not a good thing, to the point where it actually can cause some poor side effects especially long-term to our organs and to the blood vessels themselves too.
Melanie: How often should people get their blood pressure checked?
Dr. Shaikh: So, it kind of depends on what your background blood pressure usually exists at. So, for initial screening, meaning that you have never had any high blood pressure measurements in the past, then once a year is a reasonable amount to check the blood pressure and this can be easily done at your annual physical which your primary care doctor. Now if there is starting to be a suspicion that your blood pressure is elevated, whether this is something that you’re feeling different symptoms indicating such as headaches, lightheadedness, dizziness, weakness, anything like that, then definitely you want to have some more intermittent checks done and also if there is a level that was noted to be a little bit above the baseline, then also that should be followed up within about a month or less depending if you are not feeling well, just to kind of corroborate and see whether the blood pressure is starting to take an incline. And once it is established that the blood pressure is abnormal, then of course, it should be followed up more regularly and especially if there has been medical therapy that has been initiated between you and your doctor as well, just to see how you are responding to that.
Melanie: So, we have always heard systolic, borderline, 130, 139 and around there. It should be 120/80. Everybody hears these numbers. They don’t know what they mean, but there are new guidelines. So, explain the new guidelines? What has changed?
Dr. Shaikh: What’s changed is that in terms of the first suspicion of diagnosing what elevated blood pressure is; that threshold has changed. So, now when the blood pressure is starting to be elevated above even a level of 120/80, that’s now an indication that there could be what’s called pre-hypertension brewing. And this means that we need to be a little bit more suspicious and aggressive about following up the blood pressure. If it then continues to elevate especially above of level of 130 for the systolic number, then there may be initiation of both diet and lifestyle modifications before the number gets even higher.
Melanie: So, typically, what is the treatment when somebody first, now that these guidelines have changed, does this mean that more people will now have high blood pressure? Is that what we’re going to see with these guidelines being changed?
Dr. Shaikh: What’s going to happen, is we are going to start and by we, meaning both the physicians and people as well, we are going to start flagging numbers and flagging patients a little bit more just so we are more on top of that trend before a significant amount of blood pressure develops. It’s actually a good thing. Because our level of suspicion will be a little bit higher and this means that we can then prevent both medication initiation because maybe we are able to impact the blood pressure with just diet changes and exercise initiation and hopefully try to prevent the blood pressure from getting higher and if not, we will be able to control the blood pressure better before it causes long-term damage. So, definitely overall statistically, it is going to look like more people have high blood pressure; but it’s a good thing, because it’s all in the effort of decreasing long-term changes such as heart disease and kidney disease and other items like that.
Melanie: And that was going to be my next question. So, if you do determine that someone has high blood pressure, especially with these new guidelines, what’s your first thing? Are you going to talk to them about diet and exercise and salt intake and their weight and all of these other things or does it go straight to medication?
Dr. Shaikh: No, definitely not straight to medication. There is believably a lot of things that we can do just in terms of watching our sodium intake, making sure that we start to become label readers and really try to find out maybe what are those items that we’re taking in our diet that seemed a little bit innocent, but may contain a third or half of our daily sodium intake and then also trying to work against the sedentary lifestyle that we all tend to fall into which is not having a good exercise capacity and exercise endurance. Believe it or not, even getting a regular amount of exercise into your schedule, at least three to four days a week; that by itself will drop the blood pressure quite a few points. In addition, if we try to have a diet that is more consistent with low sodium intake and particularly a very evidence corroborated diet called the DASH diet, that also has been known to drop the blood pressure more than ten points if followed well. And there’s a lot of other basically lifestyle approaches that we can make before medication is needed. Now, if those changes are in effect and despite all measurements, it seems that the blood pressure is still elevated, then obviously, medication could be in your best interest, but definitely both you and your physician provider will work together to see if there are other changes that can be made first.
Melanie: So, speak about the DASH diet and salt intake, because people aren’t sure Dr. Shaikh, if this is a myth, does salt really contribute to high blood pressure? Is it something that really you need to start looking at labels? What is the DASH diet and speak about salt for a minute as part of a plan and a comprehensive plan to keep lower blood pressure?
Dr. Shaikh: The DASH diet, believe it or not, it’s been around for quite a while. But it’s not maybe spoken about as much as it should be. There’s also a DASH diet that can help you even with just weight loss, but in particular, the one that I speak of is more in terms of sodium reduction. So, it really stands for dietary approaches to stop hypertension. So, what we found with the DASH diet, is that it is the first line indicated therapy when we suspect that the blood pressure is high. And the sodium intake, we really want to try to get it under 3 grams and even lower than that even under 2 and a half grams or 2 grams per day, especially if you have other concomitant medical issues in addition to high blood pressure.
So, this means starting to become a label reader. So, a lot of us are obviously eating products that are partially made or at least half way prepared by outside companies in addition to what we are cooking from scratch at home. So, it really involves taking a look and you can do this right now with any item that is in your kitchen when you look at the ingredients label and look at what the actual percentage is of sodium that is in that item as compared to what your recommended daily intake is. So, there’s very good information for it on the internet and it’s a pretty self-explanatory method, but really can make a large impact. So, it seems, it’s one of those items that we have available to us on a daily basis and we just need to take advantage of it. Especially if it means less blood pressure medications in the future for all of us.
Melanie: Certainly true. And just to exercise for a minute. How much exercise do you truly need because, the studies have been shown that exercise can lower your blood pressure just from one bout for up to four hours post exercise session. What does that mean for people that do have hypertension, high blood pressure? How often should they be exercising?
Dr. Shaikh: Well, I try to keep things pretty simple when I advise people because obviously, everybody is very busy with their own lives and as a provider, I want to make sure that I’m giving people advice that is easy to digest. Pun intended. But in general, the amount of exercise that is recommended in a week is 120 minutes at least and this is of a good intensity exercise. So, for example if you work at a type of office where you are walking around a fair amount of the day, that doesn’t necessarily count towards that 120 minutes. We are talking about exercise that really elevates your heart rate up and significantly feels like you are doing more than your average amount of activity. So, a total of 120 minutes a week. This can be broken up either into three days, four days, five days whatever works for you. What I generally advise too is to kind of implement it into your daily schedule. So, this means it’s that walk in the morning before you go to work, or possibly after dinner that you and your significant other do, so this way it can even be part of your daily routine and honestly, exercise is good for everybody overall, not just for high blood pressure but can help in a lot of different ways and definitely has been proven to help decrease cardiovascular events in the future.
Melanie: Wrap it up for us Dr. Shaikh. It’s great information on why people need to know about these new guidelines and why they are so important that we all need to really keep track of our blood pressure.
Dr. Shaikh: Sure. So, the both dietary, exercise recommendations, using the DASH diet, all these items, these are easy toolboxes that are available. They are free. You can discuss them with your doctor, discuss them with your family and make sure that everybody implements them together because with the new guidelines, what we are doing is we are trying to target problem situations and the brewing of high blood pressure earlier. Why? Because it seems that with the older recommendations, we are still missing people. We are missing people, and this means that disease is progressing, disease that’s easily preventable. And again, an ounce of prevention is always worth more than a pound of treatment and these new guidelines are just another example of that. But definitely, take action, get your blood pressure measured whether it’s walking into a local pharmacy or convenience store or just popping into your doctor’s office for an extra visit. But definitely knowing earlier is important and that’s what these guidelines are really showing.
Melanie: Thank you so much for being with us today. Really, it’s just such important information for listeners to hear. This is Lourdes Health Talk. For more information and to learn more about cardiology services at Lourdes Health System, please visit www.loudresnet.org that’s www.lourdesnet.org . This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Understanding your blood pressure numbers is key to controlling high blood pressure and there’s new, updated guidelines recently changed and here to talk about those with us is Dr. Hafeza Shaikh. She’s a cardiologist with Lourdes Health System. Dr. Shaikh, so give us a little physiology lesson. What is blood pressure? Because people don’t even really understand what it is or the importance of it.
Hafeza Shaikh, DO (Guest): Sure. Well thank you first of all, for having me on this morning. It’s a pleasure to speak with you about this super important topic. So, in terms of high blood pressure, what it really means is within our arteries and veins, our fluid, our blood system is responsible for being at a certain pressure to make sure that all the organs in our body are getting the proper circulation that they should be getting. Unfortunately, though for especially a large sized population in the United States, a lot of us have the condition where that tension and that pressure is too high. And too high in this situation is not a good thing, to the point where it actually can cause some poor side effects especially long-term to our organs and to the blood vessels themselves too.
Melanie: How often should people get their blood pressure checked?
Dr. Shaikh: So, it kind of depends on what your background blood pressure usually exists at. So, for initial screening, meaning that you have never had any high blood pressure measurements in the past, then once a year is a reasonable amount to check the blood pressure and this can be easily done at your annual physical which your primary care doctor. Now if there is starting to be a suspicion that your blood pressure is elevated, whether this is something that you’re feeling different symptoms indicating such as headaches, lightheadedness, dizziness, weakness, anything like that, then definitely you want to have some more intermittent checks done and also if there is a level that was noted to be a little bit above the baseline, then also that should be followed up within about a month or less depending if you are not feeling well, just to kind of corroborate and see whether the blood pressure is starting to take an incline. And once it is established that the blood pressure is abnormal, then of course, it should be followed up more regularly and especially if there has been medical therapy that has been initiated between you and your doctor as well, just to see how you are responding to that.
Melanie: So, we have always heard systolic, borderline, 130, 139 and around there. It should be 120/80. Everybody hears these numbers. They don’t know what they mean, but there are new guidelines. So, explain the new guidelines? What has changed?
Dr. Shaikh: What’s changed is that in terms of the first suspicion of diagnosing what elevated blood pressure is; that threshold has changed. So, now when the blood pressure is starting to be elevated above even a level of 120/80, that’s now an indication that there could be what’s called pre-hypertension brewing. And this means that we need to be a little bit more suspicious and aggressive about following up the blood pressure. If it then continues to elevate especially above of level of 130 for the systolic number, then there may be initiation of both diet and lifestyle modifications before the number gets even higher.
Melanie: So, typically, what is the treatment when somebody first, now that these guidelines have changed, does this mean that more people will now have high blood pressure? Is that what we’re going to see with these guidelines being changed?
Dr. Shaikh: What’s going to happen, is we are going to start and by we, meaning both the physicians and people as well, we are going to start flagging numbers and flagging patients a little bit more just so we are more on top of that trend before a significant amount of blood pressure develops. It’s actually a good thing. Because our level of suspicion will be a little bit higher and this means that we can then prevent both medication initiation because maybe we are able to impact the blood pressure with just diet changes and exercise initiation and hopefully try to prevent the blood pressure from getting higher and if not, we will be able to control the blood pressure better before it causes long-term damage. So, definitely overall statistically, it is going to look like more people have high blood pressure; but it’s a good thing, because it’s all in the effort of decreasing long-term changes such as heart disease and kidney disease and other items like that.
Melanie: And that was going to be my next question. So, if you do determine that someone has high blood pressure, especially with these new guidelines, what’s your first thing? Are you going to talk to them about diet and exercise and salt intake and their weight and all of these other things or does it go straight to medication?
Dr. Shaikh: No, definitely not straight to medication. There is believably a lot of things that we can do just in terms of watching our sodium intake, making sure that we start to become label readers and really try to find out maybe what are those items that we’re taking in our diet that seemed a little bit innocent, but may contain a third or half of our daily sodium intake and then also trying to work against the sedentary lifestyle that we all tend to fall into which is not having a good exercise capacity and exercise endurance. Believe it or not, even getting a regular amount of exercise into your schedule, at least three to four days a week; that by itself will drop the blood pressure quite a few points. In addition, if we try to have a diet that is more consistent with low sodium intake and particularly a very evidence corroborated diet called the DASH diet, that also has been known to drop the blood pressure more than ten points if followed well. And there’s a lot of other basically lifestyle approaches that we can make before medication is needed. Now, if those changes are in effect and despite all measurements, it seems that the blood pressure is still elevated, then obviously, medication could be in your best interest, but definitely both you and your physician provider will work together to see if there are other changes that can be made first.
Melanie: So, speak about the DASH diet and salt intake, because people aren’t sure Dr. Shaikh, if this is a myth, does salt really contribute to high blood pressure? Is it something that really you need to start looking at labels? What is the DASH diet and speak about salt for a minute as part of a plan and a comprehensive plan to keep lower blood pressure?
Dr. Shaikh: The DASH diet, believe it or not, it’s been around for quite a while. But it’s not maybe spoken about as much as it should be. There’s also a DASH diet that can help you even with just weight loss, but in particular, the one that I speak of is more in terms of sodium reduction. So, it really stands for dietary approaches to stop hypertension. So, what we found with the DASH diet, is that it is the first line indicated therapy when we suspect that the blood pressure is high. And the sodium intake, we really want to try to get it under 3 grams and even lower than that even under 2 and a half grams or 2 grams per day, especially if you have other concomitant medical issues in addition to high blood pressure.
So, this means starting to become a label reader. So, a lot of us are obviously eating products that are partially made or at least half way prepared by outside companies in addition to what we are cooking from scratch at home. So, it really involves taking a look and you can do this right now with any item that is in your kitchen when you look at the ingredients label and look at what the actual percentage is of sodium that is in that item as compared to what your recommended daily intake is. So, there’s very good information for it on the internet and it’s a pretty self-explanatory method, but really can make a large impact. So, it seems, it’s one of those items that we have available to us on a daily basis and we just need to take advantage of it. Especially if it means less blood pressure medications in the future for all of us.
Melanie: Certainly true. And just to exercise for a minute. How much exercise do you truly need because, the studies have been shown that exercise can lower your blood pressure just from one bout for up to four hours post exercise session. What does that mean for people that do have hypertension, high blood pressure? How often should they be exercising?
Dr. Shaikh: Well, I try to keep things pretty simple when I advise people because obviously, everybody is very busy with their own lives and as a provider, I want to make sure that I’m giving people advice that is easy to digest. Pun intended. But in general, the amount of exercise that is recommended in a week is 120 minutes at least and this is of a good intensity exercise. So, for example if you work at a type of office where you are walking around a fair amount of the day, that doesn’t necessarily count towards that 120 minutes. We are talking about exercise that really elevates your heart rate up and significantly feels like you are doing more than your average amount of activity. So, a total of 120 minutes a week. This can be broken up either into three days, four days, five days whatever works for you. What I generally advise too is to kind of implement it into your daily schedule. So, this means it’s that walk in the morning before you go to work, or possibly after dinner that you and your significant other do, so this way it can even be part of your daily routine and honestly, exercise is good for everybody overall, not just for high blood pressure but can help in a lot of different ways and definitely has been proven to help decrease cardiovascular events in the future.
Melanie: Wrap it up for us Dr. Shaikh. It’s great information on why people need to know about these new guidelines and why they are so important that we all need to really keep track of our blood pressure.
Dr. Shaikh: Sure. So, the both dietary, exercise recommendations, using the DASH diet, all these items, these are easy toolboxes that are available. They are free. You can discuss them with your doctor, discuss them with your family and make sure that everybody implements them together because with the new guidelines, what we are doing is we are trying to target problem situations and the brewing of high blood pressure earlier. Why? Because it seems that with the older recommendations, we are still missing people. We are missing people, and this means that disease is progressing, disease that’s easily preventable. And again, an ounce of prevention is always worth more than a pound of treatment and these new guidelines are just another example of that. But definitely, take action, get your blood pressure measured whether it’s walking into a local pharmacy or convenience store or just popping into your doctor’s office for an extra visit. But definitely knowing earlier is important and that’s what these guidelines are really showing.
Melanie: Thank you so much for being with us today. Really, it’s just such important information for listeners to hear. This is Lourdes Health Talk. For more information and to learn more about cardiology services at Lourdes Health System, please visit www.loudresnet.org that’s www.lourdesnet.org . This is Melanie Cole. Thanks so much for listening.
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