Einstein Expert: African-Americans Benefit Most from New Blood Pressure Guidelines
African-Americans, who have the highest rates of high blood pressure in the world, will benefit the most from the new guidelines that set a lower threshold for healthy levels, according to Einstein cardiologist Olayinka Afolabi-Brown, MD.
“They’re likely to benefit the most because they have a higher prevalence of hypertension and we know that hypertension is one of the most important modifiable risk factors for heart disease,” Dr. Brown said in the aftermath of the dramatic change in standards recommended recently by the American Heart Association.
According to the Heart Association website, the prevalence of hypertension in African-Americans in the United States is among the highest in the world. More than 40 percent of non-Hispanic, African-American men and women have high blood pressure. For African-Americans, high blood pressure also develops earlier in life and is usually more severe.
“They’re likely to benefit the most because they have a higher prevalence of hypertension and we know that hypertension is one of the most important modifiable risk factors for heart disease.”
The new guidelines set healthy blood pressure at 120/80 or below with high blood pressure now defined as a blood pressure above 130/80, a ten-point drop in the top number. Patients with the higher numbers will be guided towards lowering their blood pressure by changes in lifestyle, Dr. Brown said. Patients who’ve had a heart attack, stroke or diabetes, or who otherwise rank high on a risk measurement scale because of, say, age—will additionally be steered towards medication.
“We’ve known for a long time that the cardiovascular risk associated with high blood pressure doubles every 10 points starting with blood pressure as low as 115 but we had not been able to prove that if we lower it with medications, we’d benefit the patients,” Dr. Brown said. “But now there have been trials that proved the benefits,” he said, citing in particular the 2015 study that included elderly patients, Sprint Trial, in which the participants who achieved blood pressure below 120 lowered the incidence of heart attacks, heart failure and stroke by a third and the risk of death by a quarter.
Dr. Brown said the news of the changed guidelines has been so pervasive that patients are taking the initiative to inquire about it. “I’m still reviewing the data myself and trying to figure out how best to implement the changes,” he said.
Meanwhile, Dr. Brown recommends that patients who are now reclassified as having high blood pressure incorporate lifestyle changes such as:
- Brisk exercise that increases the heart rate 30 minutes five times a week, or 45 minutes three times a week.
- Limit salt intake to less than two grams a day.
- Keep weight down by cutting calorie intake 10 per cent a day until optimum weight is achieved.
- Stop smoking.
- Limit alcohol to one drink a day for women and two drinks for men.
- Strive to get eight hours of sleep a night. Sleep apnea sufferers should seek medical help because breathing pauses increase blood pressure.
- Practice meditation, yoga or other stress-reducing activities.