Jerusalem Post

ByDORON KUPERSTEIN

For years, doctors used clear numbers to define normal blood pressure, but in recent years the definitions have been changing again and again following new studies.

Blood pressure is one of the most commonly measured medical indicators in the world. At almost every visit to the doctor, the two familiar numbers representing the pressure in the arteries during heart activity are measured. For years, it seemed that medicine had already clearly defined what normal blood pressure is and what is considered hypertension.
However, in the last decade these definitions have been changing repeatedly. More and more experts believe that even values that were once considered borderline or normal may be dangerous to health in the long term.

This change is not occurring only in the field of blood pressure. This week, new guidelines were also published in the field of cholesterol that propose starting treatment earlier in relatively young people. In both cases, this is a new medical approach that emphasizes early prevention and an attempt to reduce cumulative risk over a lifetime.
A case that illustrates the problem

Dr. Mark Supiano, a geriatrician at the University of Utah, recalls a 78-year-old patient who came to him in 2017 due to a decline in memory. During the examination of vital signs, he noticed a measurement that particularly concerned him.
Her blood pressure was 148 over 86 even though she was already taking two medications to lower blood pressure.

According to Supiano, there were several possible factors for this. The patient was taking an anti-inflammatory medication for joint pain, consumed a diet high in salt, did not exercise regularly, and also used to drink two glasses of wine every evening.
Her case demonstrates how a combination of lifestyle habits and various medical factors may gradually raise blood pressure over the years.

Why the threshold for diagnosis is decreasing

In the past, doctors used to define hypertension when the measurement exceeded 140 over 90. However, in recent years many guidelines around the world determine that values of 130 over 80 may already be considered hypertension.

The main reason for the change is studies that showed that even blood pressure that was once considered borderline increases the risk of heart disease and stroke.
In addition, studies indicate a connection between high blood pressure and cognitive decline and even an increased risk of dementia. Researchers believe that high blood pressure over the years damages the small blood vessels in the brain and causes cumulative damage.

Therefore, some experts believe that it is better to start treatment earlier before the damage accumulates.
Last month cholesterol also enters the picture

Last month, new guidelines were published by the American College of Cardiology and the American Heart Association that call for considering starting cholesterol-lowering treatment already in the thirties in certain cases.
According to the new guidelines, people aged thirty and above with high levels of LDL cholesterol or with an increased risk of heart disease may benefit from earlier treatment with medications from the statin family.
These medications work by lowering the levels of bad cholesterol in the blood and thus reduce the buildup of plaque in the arteries.
In the past, doctors mainly focused on the risk for the next ten years. However, the new guidelines propose looking also at the cumulative risk over thirty years.
The meaning is that a relatively young person with risk factors may receive a recommendation for early treatment even if their risk of a heart attack in the coming decade is still low.
Why it is important to start early

The reason for the change is a new scientific understanding. Many studies indicate that prolonged exposure to high levels of cholesterol is one of the main factors in the buildup of plaque in the arteries.
That is, the longer cholesterol remains high over many years, the greater the risk of a heart attack or stroke later in life.
Therefore, some experts argue that earlier treatment may reduce cumulative damage and decrease the overall risk of heart disease.
Millions may be affected

The meaning of the changes in the guidelines is that millions of people around the world may find themselves in a risk group earlier.
However, it is important to understand that a diagnosis does not necessarily immediately lead to drug treatment. In most cases, the first recommendation is a change in lifestyle.
The recommendations include reducing salt and fat intake, maintaining a normal body weight, regular physical activity, and reducing alcohol consumption.
Sometimes these changes alone are enough to significantly improve blood pressure and cholesterol levels.
Despite the broad support for the new approach, there are also doctors who warn against expanding the diagnosis too much. According to them, there is concern that relatively young and healthy people will receive drug treatment too early.
In addition, cholesterol-lowering medications may cause side effects in some patients such as muscle pain or weakness.
Therefore, the decision on treatment should be made after a discussion between the doctor and the patient, taking into account personal risk factors and patient preferences.
Despite the disagreements among experts, there is one point on which everyone agrees. Heart diseases do not develop in one day but over many years. Therefore, early prevention is one of the most important tools for maintaining heart and brain health.
Periodic measurement of blood pressure, checking cholesterol levels, and maintaining a healthy lifestyle may significantly reduce the risk of a heart attack or stroke in the future.
In other words, the numbers may change, but the message is clearer than ever. The earlier risk factors are treated, the greater the chance of avoiding serious health problems later in life.