How Low Should Blood Pressure Go?

When it comes to blood pressure guidelines, it’s a question cardiologists have puzzled over for years – just how low should blood pressure go? Well, according to articles released by nearly every major news outlet, including The New York Times, US News & World Report, FOX News and NBC News, federal health officials have declared they have “potentially lifesaving information” as a result of a recent major study – one that they are ending a year early because it has already conclusively answered this question.

For accuracy purposes, some diagnostic tests require a little preparation on your part. So, what do you need to do before you have a cardiac stress test? According to a recent publication by the Heart and Vascular Team at the Cleveland Clinic, the following tips are good to know before you step on the treadmill:

The US Preventive Services Task Force (USPSTF) Weighs In

According to the Centers for Disease Control and Prevention, 67 million American adults (31%) have high blood pressure – that’s 1 out of every 3 adults. Depending upon the severity of the condition, typically diagnosed by in-office BP measurements, blood pressure medication and/or lifestyle modifications may be prescribed.

Although in-office BP measurements are typically used to diagnose hypertension, several studies have shown that other diagnostic options are far more reliable - specifically, the use of a 24-hour, ambulatory blood pressure monitoring device (ABPM).

Were You Properly Diagnosed?

A vast amount of physicians are diagnosing hypertension without properly assessing a patient’s blood pressure during the course of a 24-hour period using Ambulatory Blood Pressure Monitoring. Simply put, ABPM provides valuable diagnostic information that in-clinic and home blood pressure monitoring systems are incapable of measuring including:

• BP variability and a more accurate estimation of true blood pressure
• Overnight changes in blood pressure (dipper status)
• Morning surges in blood pressure

Believe it or not, your pet can have high blood pressure too! That being said, the significance of this is a bit different than it would be for you and me. Hypertension in cats and dogs is almost always secondary, which means it is caused by an underlying condition or disease. Because secondary hypertension is a signal that something else is wrong, blood pressure screening is a great way to discover other health issues in your pet such as acute kidney disease or hyperthyroidism. BP screening can help to prevent serious organ damage if a condition or disease is caught in its early stages.

Ambulatory Blood Pressure Monitoring (ABPM) is a commonly-used tool for the identification and treatment of hypertension with a variety of clinical applications including identification of white-coat hypertension, diagnosis of masked hypertension, monitoring the efficacy of anti-hypertensive treatment, and identification of resistant hypertension. One common question from both those preparing to implement ABPM in their practice, and current ABPM users alike, is whether or not it is a reimbursable procedure.

Though we state it often, we at SunTech Medical aren't the only ones touting the utility of monitoring BP outside of a clinical setting. A recent article published by a northeastern regional news website advocates for the use of home BP (HBPM) and ambulatory BP monitoring (ABPM) to diagnose and monitor hypertension. An estimated 50% of patients experience either white coat hypertension or masked hypertension. Therefore, as Dr. David Landers is quoted in the article, "'One blood pressure reading in the office is not useful. What you need is more data points.'"

 My mother was recently diagnosed with high Blood Pressure (BP). She talked to her doctor about the best ways to help control her high BP. The doctor prescribed a blood pressure medication and recommended she should eat more fruits and vegetables in addition to adding 30 minutes of exercise to her daily routine.

I was happy that the doctor recommended a healthy lifestyle to her in addition to the medication. I wouldn't call myself a health nut, maybe an enthusiast – which is why I liked the idea of alternatives for her. Recently, I read a study in the American Heart Association journal Hypertension, about how drinking a cup (250ml) of beetroot juice a day could help lower High BP.

At Blog@SunTech, monitoring blood pressure on a regular basis is a common point of discussion especially as it relates to hypertension. Blood pressure measurement is an important part of overall health assessment and is typically the first piece of data collected for any office visit...with the exception of one rather important field of practice.

When all else fails, keep it simple. Isn’t this what we have been told since childhood? It seems that some cardiologists have gone back to this basic philosophy when it comes to diagnosing heart disease. Dr Martha Gulati, a cardiologist at the Ohio State Wexner Medical Center where she specializes in women’s heart disease, says that it is “simple stuff” like an exercise stress test that can “catch blockages and predict hypertension” that other more high-tech tests sometimes miss. She says that using an exercise stress test in a recent case allowed her to “find significant disease” that other tests like an MRI completely missed.

Three months ago, the National Institute for Health and Clinical Excellence (NICE) in the UK released new guidelines for managing hypertension in adults. The new recommendations call for the use of Ambulatory Blood Pressure Monitoring (ABPM) to confirm a diagnosis of hypertension when a patient has a clinic BP reading of 140/90 mmHg or above. One of the major questions raised was how this would be implemented.

Here on the SunTech blog, we normally aim to provide valuable clinical information and helpful tips related to all things blood pressure. But allow me to wax philosophical for a moment, because…well, you’ll see why.

Right. So, for many of us who work in health-care or a health-care related field, there is significant meaning to be found in doing a job that can positively affect people’s well-being. It’s great to wake up every day knowing that you will indirectly or directly help to cure illnesses, heal wounds, save lives, and treat burns due to water skis on fire…wait, huh?

Hypertension is a prevalent condition globally and is quickly becoming a focus in the U.K., with particular emphasis on how to best diagnose the condition. In August, a study comparing blood pressure (BP) measurement methods, which was funded by the U.K.’s National Institute for Health and Clinical Excellence (NICE), was published on the same day that NICE announced the release of its new guidelines for hypertension management in adults.

In the study, Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study, the research found that “ambulatory monitoring is cost effective compared with further monitoring in the clinic or home for confirming the diagnosis of hypertension” for all age and gender groups considered. Specifically, ABPM provided cost savings ranging from £56 in men aged 75 years to £323 in women aged 40 years (Equivalent to $89 and $511 respectively). Additionally, it was determined that ambulatory blood pressure monitoring (ABPM) “resulted in improved health outcomes for male and female age groups older than 50.”

Dr. Henry Black, former President of the American Society of Hypertension, presents this very question in his recent video on Medscape News. While Medscape requires a free login account to view their content, we felt this report rather significant and worthy of sharing.

In the video article, Dr. Black points out that the practices of how we measure blood pressure are changing as technology advances and becomes more available. He also explains that while home monitoring is becoming more commonplace, studies of ambulatory blood pressure monitoring (ABPM) are telling us more about its unique prognostic benefits. 

We recently came across an article reporting on a man in Grand Forks, North Dakota, who is so upset about the erroneously high readings from his new BP monitor that he spent three days protesting outside the store he purchased it from*.

A recent article in the Journal of Clinical Hypertension does a colorful yet effective job of describing the transient effects of White Coat Hypertension (WCH) when meeting  a new physician.  Studies show that patients who are not hypertensive but show high BP readings when visiting a new doctor for their first time can continue to present with these elevated BP readings for three to six visits.  Although treatment for hypertension based on these measurements is not recommended, the gold standard diagnostic test for WCH, a 24-hour study with an ambulatory blood pressure (ABP) monitor, can more effectively determine whether treatment is, in fact, needed.

Thanks to the increasing concern regarding cardiovascular disease, blood pressure (BP) is one of the more well-known vital signs. Just about everyone has had their BP measured in a clinic. In the last few years, many track their own BP with the widespread availability and affordability of home monitors. Although experts in cardiology regard ambulatory blood pressure monitoring (ABPM) as the gold standard, it is not as frequently used in regular medical practice as in-office or home BP.
Each method has its benefits and disadvantages.

We’ve already discussed how hypertension is a costly drain on worldwide health care systems and society in general, but this cost is only based on adult hypertension.  A recently published report advocates improving the awareness, identification, and treatment of pediatric hypertension and clearly describes the implications of continuing to neglect this problem in the pediatric population.  The prevalence of hypertension in children is about 3-5% of the population, but as obesity continues to rise in children, high blood pressure will likely increase making it even more important to raise the awareness of pediatric hypertension.

Earlier this year we wrote a blog post about the similarities of current healthcare challenges in both China and the US. Of particular note was the fact that Hypertension is the leading cause of premature deaths in China. We recently had an opportunity to meet and speak with many folks involved with the delivery of healthcare in this rapidly evolving market at the China Medical Equipment Fair (CMEF) held in Shenzhen April 18 - 21, 2010.

An important health issue that expectant mothers may encounter during pregnancy is Preeclampsia, a condition in which the expectant mother is diagnosed with hypertension and has protein present in the urine.  Preeclampsia is the most common medical disorder of pregnancy and affects 10%-12% of all expectant mothers (Pickering et al, 2005).  Since blood pressure plays an important role in the health of mom and baby, accurate blood pressure measurement is extremely critical, because one would never want to be misdiagnosed with hypertension and be prescribed medications/medical interventions that could potentially injure both mom and baby.