New Guidelines Expand Definition of High Blood Pressure

By Jane Farrell

Experts are resetting the numbers indicating high blood pressure, and that means that 46 percent of U.S. adults now are identified as having the condition, compared with 32 percent under the previous definition.

Those guidelines, released Monday, Nov. 14, by the American Heart Association (AHA), also redefine the condition and provide tactics for doctors to detect, treat and prevent it.

People with a reading of 130 as the top number or 80 at the bottom one are now considered to have high blood pressure. The old guidelines were defined as 140/90.

A blood pressure of less than 120/80 still will be considered normal, but levels at or above that, to 129, will be called “elevated,” according to AHA News.

Blood pressure, the AHA explains, is recorded as two numbers:

• Systolic blood pressure (the upper number) — indicates how much pressure your blood is exerting against your artery walls when the heart beats.
• Diastolic blood pressure (the lower number) — indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

More attention is typically given to systolic blood pressure (the top number) as a major risk factor for cardiovascular disease for people over 50, the AHA says. In most people, systolic blood pressure rises steadily with age because of the increasing stiffness of large arteries, long-term build-up of plaque and an increased incidence of cardiac and vascular disease.

The association said that the guidelines aim to help people take control of their blood pressure earlier. High blood pressure (hypertension) is a major risk factor for heart disease and stroke.

“Yes, we will label more people hypertensive and give more medication, but we will save lives and money by preventing more strokes, cardiovascular events and kidney failure,” said Kenneth Jamerson, M.D., Ph.D., professor of internal medicine and hypertension specialist at the University of Michigan Health System, said in the news release. Jamerson is one of 21 experts on the guideline writing committee. “If you are going to put money into the healthcare system, it’s to everyone’s advantage if we treat and prevent on this side of it, in early treatment.”

AHA News said the guidelines have been in the works for about three years. The previous guidelines were released in 2003.

In the news release, the AHA emphasized that the guidelines, published in the association’s journal Hypertension, don’t suggest a huge increase in the number of people who will need to take medicine to control high blood pressure.

Of the estimated 14 percent more adults to be classified with high blood pressure, about one in five will need medication, according to Paul Whelton, M.D., who chaired the guideline writing committee.

The news release also said that doctors should focus on “a whole framework of healthier lifestyle changes for patients.”

“We need to send the message that yes, you are at increased risk and these are the things you should be doing,” said Whelton, chair of global public health at Tulane University in New Orleans. “I’m not saying it’s easy to change our lifestyles, but that should be first and foremost.”

Recommendations for a heart-healthy diet include reducing salt and incorporating potassium-rich foods such as bananas, potatoes, avocados and dark leafy vegetables. Lifestyle changes include weight loss, quitting cigarettes, cutting back on alcohol and increasing physical activity.

Robert M. Carey, M.D., vice chair of the guideline writing committee, said, according to AHA News, that he expects some controversy over how the report treats older adults. It recommends people 65 and older be treated to the same 130/80 goal as younger patients. A guideline early this year from the American College of Physicians and the American Academy of Family Physicians suggested patients 60 and older be held to a standard below 150/90.

The new classifications and recommendations are specific in how they determine who is at risk and what they should do about it, Jamerson said.

Doctors should use a “risk calculator” to determine a patient’s risk of heart disease or stroke over the next 10 years. That assessment, combined with the other recommendations, can prompt more thorough doctor-patient conversations to determine whether lifestyle changes alone can help, or if medicine is needed as well.

“These new guidelines give patients a voice because it gives them an opportunity to ask healthcare providers, ‘What’s my risk?’” Jamerson said in the news release “Consumers should be getting an explanation. Physicians ought to be calculating risk as they think about how to treat.”

The AHA released the following breakdown of blood pressure numbers and recommendations on how to treat them.

Normal blood pressure: 120/80 Healthy lifestyle choices and yearly checks.

Elevated blood pressure: 120-129/80 Healthy lifestyle changes, reassessed in three to six months.

High blood pressure, stage 1: 130/139 OR 80/89 Ten-year heart and stroke risk assessment. If less than 10 percent risk, lifestyle changes, reassessed in three to six months. If higher than 10 percent risk, lifestyle changes and medication with monthly follow-ups until BP controlled.

High blood pressure, stage 2: 140 OR 90 Lifestyle changes and two different classes of medicine, with monthly follow-ups until BP is controlled.

Click here for a blood pressure calculator, and here for a cardiovascular risk calculator. For more information on high blood pressure, click here.

Courtesy of American Heart Association News.