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Borderline hypertension: When do you need treatment?

Many people develop high blood pressure during their lifetime. These steps may delay your need to take medicines.

Hypertension, defined as a blood pressure reading of 140/90 mm Hg or above, is the primary risk factor for heart attack and stroke. Additionally, it sets the stage for other serious conditions, such as kidney failure, blood vessel damage, vision loss, and dementia.

But these perils do not suddenly appear as blood pressure readings cross the 140/90 mm Hg threshold. Instead, your risks of heart disease and other complications creep up as your numbers do.

The gray area

More than one in three Americans fall into a somewhat murky risk zone, known as prehypertension or borderline hypertension, where blood pressures are above the upper boundary of “normal” (120/80 mm Hg) but have not yet crossed into hypertensive territory.

“We don’t treat people with prehypertension with medications unless they have other medical conditions that put them at higher risk, such as coronary artery disease, diabetes, or chronic kidney disease,” says Dr. Randall Zusman, a hypertension specialist at Harvard-affiliated Massachusetts General Hospital. “But very few people are going to avoid getting high blood pressure, so what you’re really doing when treating borderline hypertension is delaying the need for these medications,”he adds.

Making lifestyle changes

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Avoid high-sodium processed foods and limit salt use as much as possible.

Everyone—regardless of blood pressure readings—should follow lifestyle changes that have been proven to prevent or forestall the onset of perilously high blood pressure. First on the list: Cut sodium intake to no more than 2 grams daily. Stay away from high-sodium processed foods as much as possible, and limit your use of salt while cooking and at the table. Second, follow the DASH (Dietary Approaches to Stop Hypertension) diet (see table, below). Introduced more than two decades ago, this diet has helped thousands of people reduce or eliminate their need for antihypertensive drugs.

Weight loss–which can lower blood pressure even if you lose just 5 to 10 pounds—is also key. And regular aerobic activity can lower blood pressure even if it does not lead to weight loss. Heavy alcohol consumption, either daily or in bouts of binge drinking, can elevate blood pressure, so moderation is vital. Finally, if you quit smoking, your blood pressure will drop within minutes of your last cigarette.

Deciding on medication

If your blood pressure does rise into the hypertension range, your doctor may start you on one or more blood pressure drugs. Recently, a group of hypertension experts recommended that people over age 60 take blood pressure medication only if their readings top 150/90 mm Hg. (Current guidelines call for starting drug therapy at 140/90 mm Hg.) As a result, some people may have wondered if they can stop taking their prescribed blood pressure medicines because they fall outside the newly suggested parameters. But quitting drug therapy could be a big mistake. Chances are there are good reasons to stick with your existing regimen, so talk to your doctor if you have any questions about your treatment plan.?

6 strategies to lower blood pressure without drugs

Lifestyle change

What to do

Potential reduction in systolic blood pressure (top number)

Reduce salt

Consume no more than 2 grams of sodium a day

5 to 20 mm (Hg for every 22 pounds lost)

Follow the DASH diet

Eat plenty of fruits and vegetables, choose low-fat dairy products, and reduce total fat consumption

8 to 14 mm Hg

Lose weight

Reach and maintain a normal body mass index (BMI)

2 to 8 mm Hg

Exercise regularly

Get at least 30 minutes of moderate aerobic exercise on all or most days of the week

4 to 9 mm Hg

Limit alcohol

Have no more than two drinks per day if you’re male, or one drink per day if you’re female

2 to 4 mm Hg

Quit smoking

There is no safe amount of cigarette smoking; if you smoke, try to quit

2 to 8 mm Hg

Source: Hypertension. Harvard Medical School Special Health Report. 2011.

Posted by: Dr.Health

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