Director's Cut
Dear Friends,

This month we are celebrating American Heart Month. It is fitting February is full of heart-related images of Valentine's Day. American Heart Month serves as a reminder to take care of our hearts. Heart disease is the #1 cause of mortality in people 65 years and older.

Heart disease is most often the result of uncontrolled hypertension. New guidelines define normal blood pressure as 120/80. Nearly half of all Americans have elevated blood pressure. Unfortunately, hypertension is a silent killer. It often starts in young and middle-aged people who do not become aware they have hypertension until it has caused damage to their vascular system and heart muscle. Too many Americans lead a sedentary lifestyle, eat foods high in fat, and are overweight. All these factors contribute to a growing population of adults aging with poor cardiovascular health. Unless we aggressively promote community education addressing prevention and management of hypertension, make blood pressure monitoring available in communities, and help people adhere to blood pressure medications, this population will continue to grow. People aging with hypertensive coronary disease need high-cost care and face reduced quality of life. Let's use this month to join the battle against heart disease and its place as the #1 cause of death in our population.

Happy Heart Month!

Tara A. Cortes, PhD, RN, FAAN

Less is More: New Guidelines Lower Systolic Blood Pressure Goal

Clinical Associate Professor
NYU Rory Meyers College of Nursing

Hypertension is the leading cause of death and disability. Lack of effective blood pressure control can lead to cardiovascular disease, heart failure, hemorrhagic and ischemic stroke, kidney failure, peripheral arterial disease, and cognitive decline. Recently, the American College of Cardiology/American Heart Association updated their guidelines to recommend a lower systolic blood pressure goal (SBP) of less than 130 mm Hg for adults at increased cardiovascular risk. The new guidelines emerged from a recent study finding lower systolic blood pressures were associated with significant declines in all-cause and cardiovascular mortality. Lower is better when it comes to systolic blood pressure, but how low should we go?  

The study conducted by the SPRINT Research Group tested the hypothesis that systolic blood pressure (SBP) <120 mm Hg would prevent the development of hypertension-induced complications in people at increased cardiovascular risk. Participants were randomized to the routine SBP management <140 mm Hg or the intensive intervention target of <120 mm Hg. 

To achieve target goals, people in the intervention target needed on average three anti-hypertensives compared to two in the standard group. The <120 mm Hg SPG group saw a reduction in all-cause and cardiovascular mortality but also had higher rates of adverse events such as hypotension, fainting, electrolyte abnormalities, and acute kidney injury or failure. 

Currently, less than 50% of people treated for hypertension achieve an SBP goal of <140 mm Hg. How do providers help patients achieve an even more aggressive goal of <130 mm Hg? 

Detection and treatment of blood pressure to target goals are critical for heart health. Healthcare professionals should make hypertension visible, monitoring at every clinical visit throughout the lifespan. Blood pressure measurements are often subject to error, and clinicians need to implement guideline-based recommendations to obtain accurate readings. Additionally, healthcare professionals need to encourage individuals to monitor their own blood pressure. Self-monitoring of blood pressure is associated with improved control, perhaps owing to increased awareness of the readings. 

Once hypertension is detected, adherence to lifestyle interventions and anti-hypertensive agents must be emphasized. Many patients will require the addition of three or four standard anti-hypertensives to achieve lower targets. Carefully assessing patients for hypotension and other intolerable side effects is one of the safest strategies to reduce complications and ensure compliance.

In celebration of February as “Heart Month,” let’s make blood pressure numbers visible so we can help all individuals see and meet their heart-healthy blood pressure goals. 
Group SR, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–16
RJ McManus, J Mant, MS Haque, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial
JAMA, 312 (2014), pp. 799-808

Deadline for Applications: April 15th

The Health and Aging Policy Fellows Program aims to create a cadre of leaders who will serve as change agents in health and aging policy to ultimately improve the health care of older adults. The year-long fellowship offers a rich and unique training and enrichment program that is focused on current policy issues, communication skills development, and professional networking opportunities to provide Fellows with the experience and skills necessary to help affect policy.

The program has a broad interdisciplinary focus, and Fellowship cohorts have included physicians, nurses, social workers, psychologists, food scientists, city planners, healthcare administrators, epidemiologists, economists, and lawyers from academic and practice settings, spanning career stages from newly minted PhDs to senior professors and community leaders.

For more information visit Health and Aging Policy Fellows
Take the Pressure Off, NYC!

Take the Pressure Off, NYC! (TPO NYC!) is New York City’s first comprehensive, population-wide initiative focusing on preventing and controlling high blood pressure. The initiative aims to reduce the number of New Yorkers with raised blood pressure by 150,000 by 2022 and reduce health inequities.

 The TPO NYC! Inaugural Plan outlines recommendations for action in three key areas: awareness, treatment and creation of heart-healthy communities.

Find out where you or your patients can get free blood pressure checks in NYC: