Think your blood pressure is in the normal range? Think again, with the new guidelines in place you may now be classified as having high blood pressure.
On November 13, 2017, new guidelines for blood pressure classification were released in a joint statement from the American Heart Association and the American College of Cardiology. These are the first updated guidelines since 2003. The major change is the lowering of the classification of stage 1 hypertension (high blood pressure) from 140/90 to 130/80. This will increase the percentage of adults diagnosed with high blood pressure from 32% to 46%.
The new blood pressure categories are as follows:
- Normal: < 120/80 mm Hg;
- Elevated: 120-129/<80 mm Hg;
- Stage 1 Hypertension: 130-139/80-89 mm Hg;
- Stage 2 Hypertension: >140/90 mm Hg;
This is in contrast to the old guidelines which were:
- Normal: <120/80 mm Hg;
- Prehypertension: 120-140/80-90;
- Hypertension: >140/90 under age 60 and >150/90 over age 60
As you can see these new guidelines are much more strict. There is no longer any prehypertension but only “elevated blood pressure.” Also there are no distinctions for age. All ages will be treated the same. While this will classify many more people with high blood pressure, not all will need treatment. Emphasis is now being placed on risk (similar to the guidelines for treating cholesterol) for whether or not treatment is needed.
The guidelines recommend a better emphasis on lifestyle modification to control blood pressure. This includes adhering to the DASH diet as well as reducing sodium and increasing potassium, maintaining a healthy body weight, 150 minutes of exercise weekly, and reducing alcohol intake (this is outlined further in my last post on High Blood Pressure). Medication will be used in more severe cases and in those at increased risk.
The guidelines recommend medication for those in stage 1 hypertension with a history heart disease or a 10 year risk greater than 10% (you can calculate your risk here). Medication should also be used in all people with stage 2 hypertension. All people with a history of heart attack should be treated to keep their blood pressure under 130/80.
There is also an emphasis on how to measure blood pressure. Before measuring BP in the office, you should avoid caffeine, smoking or exercise for 30 minutes. You should sit quietly for 5 minutes before measuring, empty your bladder and remain still. The arm should be supported and don’t measure over clothes. Blood pressure measurements at home can also be used more to assure home blood pressures are under control. A validated machine with an upper arm cuff should be used with the arm positioned and supported at the level of the heart.
My Take Away:
Many more people are going to be diagnosed with high blood pressure based on the new guidelines to call anything over 130/80 high blood pressure. While more will be diagnosed, hopefully not as many will need treatment and will adhere to the lifestyle recommendations to keep their BP under that level. While some may think this is being done to put more money in the pockets of big pharma, it is simply not true. Just about all of the blood pressure medications I prescribe are generic and very cheap (just look up the price on goodrx.com of lisinopril, hydrochlorothiazide, amlodipine and atenolol). In the long run, I do believe that adhering to these guidelines will decrease the overall rates of heart disease.
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To read my other post this week about the new Shingles vaccine, click here.