The Standards For High Blood Pressure Are Changing. Here’s What You Need to Know

It’s out with the old and in with the new in 2018—especially when it comes to medical guidelines about healthy blood pressure!

In late 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) issued a set of comprehensive new guidelines for the detection, prevention, management, and treatment of high blood pressure, the first such set since 2003.

All Americans should take notice of these changes, which could be a “wake-up call” for many, particularly older people, who are at higher risk of developing complications from high blood pressure.

What Is High Blood Pressure/Hypertension?

High blood pressure, also called hypertension, occurs when the force of the blood moving through your blood vessels is higher than normal.

When left unchecked, high blood pressure can lead to significant health problems, including:

  • damaged blood vessels
  • heart attacks
  • strokes
  • kidney disease
  • cardiovascular disease

All of these are worrisome—and possibly fatal. In particular, cardiovascular disease is one of the leading causes of death worldwide, and was responsible for nearly a third of global deaths in 2015, according to the World Health Organization.

What Are the New Blood Pressure Guidelines?

The new guidelines take up well over 100 printed pages, and come complete with more than two dozen listed authors and hundreds of references. In short, they’re dense and pretty complicated. But if you really want to see the full text, you can do so here.

For the rest of us, it may be helpful to look at the big picture.

The most noteworthy change is that the ACC and AHA are lowering the definition for high blood pressure.

Previously, hypertension was considered to be equal to or greater than 140/90 mm Hg. A blood pressure level between 120/80 and 139/89 was considered to be “prehypertension.”

Under the new guidelines, hypertension is now defined as 130/80 or greater. That’s a pretty significant drop! Blood pressure between 130/80 and 139/89 is categorized as Stage 1 hypertension; readings over 140/90 are now categorized as Stage 2.

The new regulations also do away with the category of prehypertension; instead, if your systolic blood pressure (that top number) is between 120 and 129, and your diastolic pressure (the bottom number) is less than 80, you now belong in an intermediate category, known as “elevated” blood pressure.

For more perspective, check out this video from the ACC:

How Will These New Blood Pressure Guidelines Affect Me?

As you may expect, these new guidelines will have a pretty sweeping effect—and could lead to many more diagnoses of high blood pressure.

The ACC anticipates that the new guidelines “will result in nearly half of the U.S. adult population (46 percent) having high blood pressure.” In particular, they anticipate that it will mostly be younger adults who are affected by the changes, rather than seniors.

However, the ACC anticipates that the new guidelines will only result in “a small increase” in the number of adults requiring antihypertensive medication.

As the lead author of the guidelines, Paul K. Whelton, MB, MD, MSc, FAHA, put it:

“We want to be straight with people—if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with nondrug approaches.”

And as Monique Tello, M.D., M.P.H., points out over at the Harvard Health Blog, the guidelines recommend “a long list of evidence-based, nondrug interventions,” rather than medications, for elevated blood pressure and Stage 1 hypertension patients. These are attainable lifestyle changes, including:

  • Embracing a diet high in fruits and vegetables
  • Decreasing consumption of salt and bad fats
  • More physical activity overall
  • Weight loss (if you are overweight or obese)
  • Reducing daily alcohol consumption

As she says:

“Simply changing what you eat can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.”

What Are My Next Steps?

For many people, this may well be a signal that it’s time to schedule an appointment with their primary care physician or cardiologist for testing or treatment.

As Valentin Fuster, MD, PhD, suggests in a blog for HuffPost:

“Many people with hypertension don’t know they have it, and even among those who are identified and treated, only about half reach the blood pressure goals needed to properly control it.”

He recommends that individuals seek treatment if they have been tested and if their levels fall at 130/80 or higher; the need for treatment becomes even more important if you:

  • are already at risk for developing cardiovascular disease due to a risk factor such as high cholesterol or a history of smoking
  • have a serious or chronic condition such as diabetes or kidney disease
  • are 65 or older

Dr. Fuster also stresses that “it is crucial that the treatment be tailored to the individual.” Dr. Tello agrees. She points out that the guidelines suggest adopting a “team approach” to treating high blood pressure, including “more and better patient education” and “ongoing monitoring.”

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