The number of Americans at risk of heart attacks and strokes is increasing rapidly. According to new statistics from the American Heart Association, around 103 million US adults have high blood pressure. The death rate from high blood pressure increased nearly 11 percent in the US between 2005 and 2015. Since the number of patients who have high blood pressure and other related disease is on the rise, it is important to ensure proper documentation of patient details, for which medical transcription services are a great support.
Guidelines published in November 2017 redefined high blood pressure reading as 130/80, which used to be 140/90. This has increased the percentage of US adults with high blood pressure from 32 percent to 46 percent. The 2017 guideline stresses individualized cardiovascular risk assessment and aggressive management of BP at levels of 140/90 mm Hg or higher in patients with a 10-year risk of cardiovascular events of more than 10%. Non-pharmacologic treatment would still be advised for patients with blood pressures of 130 to 139/80 to 89 mm Hg, unless they had a 10-year risk above 10%. In that case, along with lifestyle changes a single antihypertensive agent is usually recommended by doctors. Dr. Kenneth Jamerson, an author of the high blood pressure guidelines, says that he is advising his patients 30 minutes of physical activity five days a week and a diet program plus medication if the patient has additional heart disease risk factors. Statistics show that only about one in five Americans gets enough exercise. Poor eating habits contribute to around 45% of U.S. deaths from heart disease, stroke and Type 2 diabetes.
Here are details of the new guidelines.
Blood pressure categories are:
- Normal: Less than 120/80 mm Hg
- Elevated: Systolic between 120 – 129 and diastolic less than 80
- Stage 1: Systolic between 130 – 139 or diastolic between 80 – 89
- Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
- Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
The new guidelines eliminate “pre-hypertension”, categorizing patients as either having elevated or Stage 1 hypertension. They emphasize the importance of choosing the proper technique to measure blood pressure, and recommend the use of home blood pressure monitoring using authentic devices. The guidelines also highlight the importance of appropriate training for healthcare providers to reveal white-coat hypertension.
Here are some other important points.
- Patients must be prescribed medication for Stage I hypertension only if they have already had a cardiovascular event such as a heart attack or stroke, or are at high risk of heart attack or stroke based on age, are diabetic, or have chronic kidney disease or atherosclerotic risk.
- It is important for providers to recognize that many people may need two or more types of medications to control their BP, and that patients may take their pills more regularly if multiple medications are combined into a single pill.
- Socioeconomic status and psychosocial stress are to be identified as risk factors for high blood pressure, and that should be considered in a patient’s plan of care.
The new guidelines can increase hypertension awareness, and encourage lifestyle modifications. Despite the positive aspects of targeting higher-risk people with lower blood pressure for risk-factor modification, doctors are concerned that a new disease designation could lead to pharmacologic treatment without consideration of the patient’s risk level.
The new blood pressure guidelines could also increase the number of patients rushing to hospitals or clinics for treatment. Primary care physicians and other healthcare providers could find themselves increasingly tied down to their EHR systems. It is best in this regard to utilize EHR-integrated medical transcription services and thereby improve office efficiency and patient care.