The Medicine Cabinet-Ask the Harvard Experts: Experts recommend personalized blood pressure goal for people with heart disease

The Medicine Cabinet-Ask the Harvard Experts: Experts recommend personalized blood pressure goal for people with heart disease

By Howard LeWine, M.D., Tribune Content Agency

Q: I am 68 years old. Other than chest pain from angina if I over exert myself, I feel fine. My blood pressure has been running around 145/90. Do I need medicine to lower it?

A: Your question is very timely. For decades, high blood pressure (hypertension) was defined as a reading of 140/90 millimeters of mercury (mmHg) or higher.

In December, 2013, new guidelines suggest adults ages 60 and over of can let their blood pressure run higher, up to 150/90 mmHg.

Not everyone agrees. More recently, three highly respected medical groups have issued new advice for one group of patients. Their guidelines address the treatment of high blood pressure for someone like you; that is, a person with hypertension and coronary artery disease.

Both sets of guidelines agree a specific goal blood pressure is not appropriate for everyone. They emphasize the importance of personalizing goal blood pressure based on factors such as:

1. Age

2. Overall health

3. Risk of heart problems and stroke

4. Side effects from blood pressure medicines

5. Preferences and goals of care

It sounds like your health is good other than the angina. So your goal blood pressure might even be lower than 140/90, perhaps 130/80 mm Hg.

It’s very likely you do need high blood pressure medicine. For people like you, with both high blood pressure and coronary artery disease, the guidelines suggest two different types of drugs:

— A thiazide diuretic (water pill) such as chlorthalidone or hydrochlorothiazide.

— An angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB). Many of these medicines are sold as generics.

To help your angina, your doctor might also prescribe a beta-blocker to keep your heart from speeding up and to decrease the work of your heart.

Medicines never take the place of healthy lifestyle choices. To help your heart and lower your blood pressure:

1. If you smoke, quit now.

2. Eat a Mediterranean-style diet loaded with fruits, vegetables and whole grains.

3. Cut back on salt.

4. Stay physically active, with at least 30 minutes a day of dedicated exercise.

5. Maintain a healthy weight.

(Howard LeWine, M.D., is an assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston. He serves as Chief Medical Editor of Internet Publishing at Harvard Health Publications.)

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