ANAHEIM, Calif. — New guidelines lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition, which now plagues nearly half of U.S. adults.
High pressure, which for decades has been a top reading of at least 140 or a bottom one of 90, drops to 130 over 80 in advice announced Monday by a dozen medical groups.
The change means an additional 14 percent of U.S. adults have the problem, but only 2 percent of these newly added people need medication right away; the rest should try healthier lifestyles, which get much stronger emphasis in the new advice. Poor diets, lack of exercise and other bad habits cause 90 percent of high blood pressure.
"I have no doubt there will be controversy. I'm sure there will be people saying 'We have a hard enough time getting to 140,'" said Dr. Paul Whelton, a Tulane University physician who led the guidelines panel.
But the risk for heart disease, stroke and other problems drops as blood pressure improves, and the new advice "is more honest" about how many people have a problem, he said.
Currently, only half of Americans with high blood pressure have it under control.
The upper threshold for high blood pressure has been 140 since 1993, but a major study two years ago found heart risks were much lower in people who aimed for 120. Canada and Australia lowered their cutoff to that; Europe is still at 140 but is due to revise its guidance next year.
The guidelines were announced Monday at an American Heart Association conference in Anaheim.
WHAT THE CHANGES MEAN
The guidelines set new categories and get rid of "prehypertension":
• Normal: Under 120 over 80
• Elevated: Top number 120-129 and bottom less than 80
• Stage 1: Top of 130-139 or bottom of 80-89
• Stage 2: Top at least 140 or bottom at least 90
That means 46 percent of U.S. adults have high pressure (stages 1 or 2) versus 32 percent under the old levels.
How common it is will roughly triple in men under 45, to 30 percent, and double in women of that age, to 19 percent.
For people over 65, the guidelines undo a controversial tweak made three years ago to relax standards and not start medicines unless the top number was over 150. Now, everyone that old should be treated if the top number is over 130 unless they're too frail or have conditions that make it unwise.
"The evidence with this is so solid, so convincing, that it's hard to argue with the targets," said Dr. Jackson Wright, a guidelines panel member from University Hospitals Cleveland Medical Center. Older people "have a 35-to-50-fold higher risk of dying of a heart attack or stroke compared to younger people."
But the Cleveland Clinic's Dr. Steven Nissen said he's worried.
"Some more vulnerable patients who get treated very aggressively may have trouble with falls" because too-low pressure can make them faint, he said.
WHO NEEDS TREATMENT
Certain groups, such as those with diabetes, should be treated if their top number is over 130, the guidelines say. For the rest, whether to start medication will no longer be based just on the blood pressure numbers. The decision also should consider the overall risk of having a heart problem or stroke in the next 10 years, including factors such as age, gender and cholesterol, using a simple formula to estimate those odds.
Those without a high risk will be advised to improve their lifestyles — lose weight, eat healthy, exercise more, limit alcohol, avoid smoking.
"It's not just throwing meds at something," said one primary care doctor who praised the new approach, the Mayo Clinic's Dr. Robert Stroebel. If people continue bad habits, "They can kind of eat and blow through the medicines," he said.
The guidelines warn about some popular approaches, though. There's not enough proof that consuming garlic, dark chocolate, tea or coffee helps, or that yoga, meditation or other behavior therapies lower blood pressure long-term, they say.
The government no longer writes heart guidelines, leaving it to medical groups. Unlike previous guideline panels, none on this one have recent financial ties to industry, although some on a panel that reviewed and commented on them do.
The guidelines were published in two journals — Hypertension and the Journal of the American College of Cardiology.
HOW AND WHEN TO CHECK IT
Blood pressure should be checked at least once a year by a health professional, and diagnosing high pressure requires two or three readings on at least two occasions.
The common way uses a cuff on the upper arm to temporarily block the flow of blood in an artery in the arm and gradually release it while listening with a stethoscope and counting sounds the blood makes as it flows through the artery. But that is prone to error, and many places now use automated devices.
The guidelines don't pick a method, but recommend measuring pressure in the upper arm; devices that work on fingers or are worn on wrists "aren't ready for prime time," Whelton said.
Home monitoring also is recommended; devices cost as little as $40 to $60.
WHAT ABOUT KIDS?
Unlike adults, numbers for normal pressure in children vary with age, height and gender. Kids should be checked at least once a year for high pressure, say guidelines announced in August by the American Academy of Pediatrics.
After age 13, the levels defining high pressure are the same as for adults, said a member of the pediatrics panel, Dr. Elaine Urbina of Cincinnati Children's Hospital Medical Center.
"When you turn 18 years and one minute, you shouldn't suddenly have a new definition," she said.
WASHINGTON — The Supreme Court will hear a free speech challenge to a California law that targets anti-abortion crisis pregnancy centers, adding to a term that is loaded with First Amendment disputes.
The justices said Monday they will review the centers' complaint that the new law, pushed by an abortion-rights group, forces them to provide information about abortion and other services.
Lower courts had allowed the law to take effect. Unlicensed centers also must inform clients of their status.
Two other new cases the justices added Monday also involve free-speech claims, by opponents of a Minnesota law banning any political attire at polling places and a Florida man who contends police arrested him in retaliation for voicing his views.
In those cases as well, courts rejected the challengers' constitutional claims.
First Amendment lawyer Floyd Abrams said in an email that "the court's decision to hear three cases in one term in which distinct First Amendment claims had been made and rejected in the lower courts certainly illustrates its intense focus on cases in which freedom of expression is center stage." The Constitution's First Amendment guarantees the right to free speech.
Even before Monday, the justices had major free speech cases on their agenda.
A fight over the politically motivated reshaping of electoral districts, a major case argued last month, could turn on whether the court finds that Republican-drawn districts in Wisconsin penalize Democratic voters because of their political beliefs, in violation of the First Amendment.
Next month, the court will hear the appeal of a Colorado baker who says he should not be compelled to create a cake for a same-sex wedding.
Early next year, the justices will take up an appeal from a government worker in Illinois who says his rights are violated by a state requirement that he pay fees to the labor union that represents public employees.
The concentration of cases fits into a broader pattern that has marked the court under Chief Justice John Roberts, including the bitterly divided Citizens United decision in 2010 and related cases that struck down campaign finance limits.
But other high-profile free speech cases during Roberts' tenure have joined the court's conservative and liberal justices.
"There's a strong bipartisan consensus on the Roberts court to uphold the First Amendment tradition of protecting hate speech," said Jeffrey Rosen, president of the National Constitution Center in Philadelphia. The justices generally support limits on speech only when there's a risk of imminent violence, Rosen said.
The crisis pregnancy center appeal appears to be one of those that is more likely to divide the justices, with Anthony Kennedy as perhaps the pivotal vote.
In urging the court to stay out of the case, California Attorney General Xavier Becerra said the law was intended to make clear to the 700,000 women who become pregnant in the state each year that there is medical care, including abortion, available to people who can't afford it on their own. California said the information the centers must provide falls within well-accepted regulation of businesses and professionals.
But Michael Farris, president of the Alliance Defending Freedom legal group that is representing the centers, said government is picking winners and losers by requiring only centers that oppose abortion to display the information.
"The government should never be permitted to coerce speech it favors over speech it does not favor," Farris said.
A federal appeals court in New York struck down similar provisions of a New York City ordinance, although it upheld the requirement for unlicensed centers to say that they lack a license.
The free-speech issue has arisen in different contexts around the country.
In 2014, the 4th U.S. Circuit Court of Appeals, based in Richmond, Virginia, struck down a North Carolina law that required abortion providers to show and describe an ultrasound to the pregnant woman. The court said the law is "ideological in intent" and violates doctors' free-speech rights.
In February, the Atlanta-based 11th U.S. Circuit Court of Appeals ruled that Florida could not prohibit doctors from talking about gun safety with their patients, upending parts of a 2011 state law. Under the law, doctors faced fines and the possible loss of their medical licenses for discussing guns with patients.
The abortion-rights group NARAL Pro-Choice California was a prime sponsor of the California law. NARAL estimates that 4,000 crisis pregnancy centers operate in the U.S.
The three new cases will be argued in February or March.
Liz Smith, the syndicated gossip columnist whose mixture of banter, barbs, and bon mots about the glitterati helped her climb the A-list as high as many of the celebrities she covered, died Sunday at the age of 94.
Joni Evans, Smith's literary agent, told The Associated Press she died of natural causes.
For more than a quarter-century, Smith's column — titled simply "Liz Smith" — was one of the most widely read in the world. The column's success was due in part to Smith's own celebrity status, giving her an insider's access rather than relying largely on tipsters, press releases and publicists.
With a big smile and her sweet southern manner, the Texas native endeared herself to many celebrities and scored major tabloid scoops: Donald and Ivana Trump's divorce, Woody Allen and Mia Farrow's impending parenthood. One item proved embarrassingly premature: In 2012, she released a column online mourning the death of her friend Nora Ephron. But Ephron, who was indeed gravely ill, did not die until a few hours later and an impending tragedy that Ephron had tried to keep secret became known to the world.
Smith held a lighthearted opinion of her own legacy.
"We mustn't take ourselves too seriously in this world of gossip," she told The Associated Press in 1987. "When you look at it realistically, what I do is pretty insignificant.
"Still, I'm having a lot of fun."
"I was fortunate enough to work with the amazing Liz Smith," Al Roker tweeted. He said that during his time at WNBC, she was nothing short of "fabulous."
"Liz Smith was the definition of a lady," actor James Woods tweeted. "She dished, but always found a way to make it entertaining and fun."
After graduating with a degree in journalism from the University of Texas, Smith recalled buying a one-way ticket to New York in 1949 with a dream of being the next Walter Winchell.
But unlike Winchell and his imitators, Smith succeeded with kindness and an aversion to cheap shots. Whether reporting on entertainers, politicians or power brokers, the "Dame of Dish" never bothered with unfounded rumors, sexual preferences or who's-sleeping-with-whom.
"When she escorts us into the private lives of popular culture's gods and monsters, it's with a spirit of wonder, not meanness," wrote Jane and Michael Stern in reviewing Smith's 2000 autobiography, "Natural Blonde," for the New York Times Book Review.
But it may have been the question of her own sexuality which kept her from discussing that of the stars. A subject in the gay press for many years, Smith acknowledged in her 2000 book that she had relationships with both men and women, and confirmed a long-rumored, long-term relationship with archaeologist Iris Love.
Evans said Smith had a series of small strokes earlier this year but nothing serious that slowed her down. She was still having breakfast, lunch and dinner outings with friends, family and associates, Evans said. She called her "a light."
Born Mary Elizabeth Smith in Fort Worth, Texas, in 1923, she was the daughter of devout Baptist mother and an eccentric father. Smith said her dad received his divine inspiration more from the race track than the pulpit.
As a young girl, Smith quickly fell in love with the silver screen, since movies were one of the few things her mother did not consider a sin.
After a brief marriage while attending Hardin-Simmons University, Smith earned her journalism degree and headed off for New York with two suitcases and $50.
For nearly 30 years, Smith bounced from job to job: publicist for singer Kaye Ballard; assistant to Mike Wallace and Candid Camera creator Allen Funt; ghostwriter for Igor Cassini's "Cholly Knickerbocker" gossip column.
Smith ultimately wrote for nine New York newspapers and dozens of magazines, but it was a stint writing for Cosmopolitan that led to her break. While establishing herself as an authority on Elizabeth Taylor and Richard Burton, Smith attracted the attention of the New York Daily News.
She started her own column at the tabloid in 1976. A gossip star was born.
In 1978, during a strike at the News, Smith helped usher in the era of celebrity journalism on television by joining WNBC-TV for three nights a week commentary. Ten years later she jumped to Fox, and she later did work for the cable channel E! Entertainment Television.
During that time, Smith migrated from the News to the rival New York Post and finally to Newsday, ultimately earning salaries well into six figures. Her column was syndicated nationwide, drawing millions of readers.
Rose Santana, 18, of Reedsport, passed away in Portland on Friday, Nov. 10, 2017. Services are pending and will be announced by Dunes Memorial Chapel.
Sharon Lee Hovard, 74, of Coos Bay, passed away Nov. 5, 2017 in Coos Bay. Arrangements are under the care of Coos Bay Chapel, 7th & Anderson, 541-267-3131 www.coosbayareafunerals.com.
Alice Serena Whitney, 78, of North Bend, passed away Nov. 9, 2017 in Coos Bay. Arrangements are under the care of Coos Bay Chapel, 541-267-3131 www.coosbayareafunerals.com.
Lonnie R. Van Elsberg 86 of North Bend died Nov. 11, 2017 in North Bend. Arrangements are under the direction of Coos Bay Chapel 685 Anderson Ave. 541-267-3131. Condolences may be made at www.coosbayareafunderals.com.
Eugene Joseph Dever, age 68, of Coos Bay, passed away Nov. 10, 2017, at Coos Bay. Arrangements under the direction of Nelson's Bay Area Mortuary 541 267-4216.
Joe Lawrence, age 93, of Coos Bay, passed away Nov. 10, 2017, at Coos Bay. Arrangements under the direction of Nelson's Bay Area Mortuary 541 267-4216.
Harrison Bryant, 82, of Myrtle Point, died Nov. 10, 2017 in Tigard. Arrangements are pending with Amling/Schroeder Funeral Service - Myrtle Point Chapel, 541-572-2524.
Mary Lockhart, 96, of Myrtle Point, died Nov. 12, 2017 in Myrtle Point. Arrangements pending with Amling/Schroeder Funeral Service - Myrtle Point Chapel. 541-572-2524.
Leonard Raschke, 80, of Myrtle Point, died Nov. 12, 2017 in Myrtle Point. Arrangements are pending with Amling/Schroeder Funeral Service - Myrtle Point Chapel, 541-572-2524.
Sylvia A. Houseman, 85, of Coos Bay, passed away Nov. 12, 2017 in Coos Bay. Arrangements are under the care of Coos Bay Chapel, 7th & Anderson, 541-267-3131 www.coosbayareafunerals.com.
DEAR ABBY: I am a lesbian. My girlfriend and I have been dating for six months. We have an awesome relationship and are very happy and open with each other.
I know she has dated guys in the past -- so have I -- so I'm not worried about that nonsense at all. But I recently found something of hers that surprised me. It was a container of pregnancy tests, and one was missing with a Plan B pill alongside of it. I am not mad about it because I know stuff happens, but I would rather that it not happen in our apartment.
I'm tempted to bring it up, but I would honestly rather not discuss it at all. I just don't want anything happening in the apartment. Would it be weird if I just threw the stuff out without telling her, or should I say something?
What if she wants to keep it? I don't think that would be the case, but it would start a fight because, as a female couple, we obviously don't need a pregnancy test. I know I am overthinking this, and I could use some advice on how to handle this uncomfortable situation. -- SURPRISED ABOUT IT
DEAR SURPRISED: I'm glad you asked. Do NOT "quietly" throw out those pregnancy tests or the medication. I don't know what kind of arrangement you have with your live-in girlfriend, but if fidelity was part of the agreement, you should absolutely talk with her about what you found. It does not have to degenerate into a fight, but it's important that you know why she feels the need to be in an intimate relationship, regardless of gender, with someone else.
DEAR ABBY: My husband and I have a wonderful life and much to be thankful for, but we have no children and are usually alone on Thanksgiving and Christmas. Everyone makes such a fuss about sharing these holidays with loved ones, but I become depressed during this season.
I do volunteer work on these holidays, but still feel sad and like everyone else in the country is having a better time than I am. Any suggestions? -- NOT SO JOLLY IN ARIZONA
DEAR NOT SO JOLLY: You must be a new reader of my column or you would know that every year around holiday time I receive letters from people like you, expressing that rather than feeling joyful and elated, they feel depressed and deprived. Some of it may be the result of the incessant marketing of these holidays, which gives the impression that "everyone" is having a grand old time sipping cider, stuffing themselves with turkey and caroling under the windows of their neighbors.
An antidote for your holiday blues might be to do more than volunteer. Why don't you and your husband plan to do something special to treat yourselves, rather than stay home feeling like everyone else is enjoying themselves? Choose a different destination each year to visit and learn about.
Or invite some friends or acquaintances to join you at home. There's a saying that misery loves company, and in your case, company might be the solution to the problem.
Dear Abby is written by Abigail Van Buren, also known as Jeanne Phillips, and was founded by her mother, Pauline Phillips. Contact Dear Abby at www.DearAbby.com or P.O. Box 69440, Los Angeles, CA 90069.