Blood pressure guidelines suddenly stricter

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Do you have high blood pressure? Are you sure? New guidelines issued this week make it likely that you and millions of other Americans will be considered to have high blood pressure, also known as hypertension.

While the guidelines have changed over the years, one thing hasn’t: high blood pressure is a killer, second only to smoking as a preventable cause of heart attacks and strokes, the leading killers of Americans. Doctors will be urging patients who don’t meet the new standards to alter their diet and exercise routines and, if necessary, begin taking medication to get their blood pressure under control.

This is not really bad news for patients. Simple lifestyle changes such as eating less salt can reduce blood pressure. If medication is necessary, there are many effective medications already available, most of them available in inexpensive generic form.


So how drastic is the change? The previous guidelines defined high blood pressure as 140/90. The new standard is 130/80. The numbers come from a growing body of evidence that finds lower blood pressure greatly reduces the chances of heart attack and stroke. Older patients used to get a break but that has also changed, as researchers find that seniors also benefit from getting blood pressure much lower than had previously been considered practical.

Younger people affected

The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45 according to the report.

The new guidelines should be taken seriously, said Paul K. Whelton, M.D., lead author of the guidelines published in the American Heart Association journal, Hypertension and the Journal of the American College of Cardiology. He noted the dangers of blood pressure levels between 130-139/80-89 mm Hg.

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said in a prepared statement. “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 non-drug approaches.”

The new guidelines mean that early half of the U.S. adult population (32%) will be considered to have high blood pressure. However, there will only be a small increase in the number of U.S. adults who will require medication to get their blood pressure under control, researchers said.

The new guidelines also stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions.

Blood pressure categories

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Top number (systolic) between 120-129 and bottom number (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: Top number over 180 and/or bottom number 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 the category of prehypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).

Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines.

Damage to blood vessels begins soon after blood pressure is elevated, said Whelton, a professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans. “If you’re only going to focus on events, that ignores the process when it’s beginning. Risk is already going up as you get into your 40s.”

About the Author

Truman Lewis

Truman has been a bureau chief and correspondent in D.C., Los Angeles, Phoenix and elsewhere, reporting for radio, television, print and news services, for more than 30 years. Most recently, he has reported extensively on health and consumer issues for ConsumerAffairs.com and FairfaxNews.com.