New high blood pressure guidelines

Henrietta Brewer
November 14, 2017

Under new health guidelines for hypertension, almost half of all adults in the United States suffer from high blood pressure and are at risk of major health problems.

The update by the American College of Cardiology and the American Heart Association is based on a three-year review of nearly 1,000 studies.

High blood pressure increases the risk of cardiac problems and strokes, and is sometimes called "the silent killer" because so many adults live with high blood pressure and don't know 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", Whelton said in a press release.

"We didn't like either of those terms because we felt-at that stage-somebody is already at substantial increased risk", he said at a briefing Monday at the AHA's annual meeting in Anaheim, California. The guidelines were last revised in 2003.


This means almost half the US adult population is living with hypertension and at an increased risk of heart disease and stroke. He is chair of the 2017 Hypertension Practice Guidelines and a professor of Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans.

That means 46 percent of USA adults have high pressure (stages 1 or 2) versus 32 percent under the old levels.

Potentially deadly high blood pressure can be brought under control with a wide array of medications, many sold as relatively cheap generics.

Previously, those people were considered to have prehypertension, but not actual high blood pressure. "This now allows 14 percent of our population to understand that's a call to action". 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 change is expected to triple the number of men under age 45 diagnosed with hypertension and double the number among women the same age.


Stage 2: The top number is at least 140, or the bottom number is at least 90. Hypertension, where the force of blood pushing against blood vessel walls is elevated, is considered the second-largest cause of preventable heart disease after smoking.

That in turn means a higher risk of rhythm problems and heart failure, he said. Blood pressure is affected by a wide variety of factors including genetics, age, diet, exercise, stress and other diseases such as diabetes. "We didn't have that in previous guidelines". Normal blood pressure still will be considered 120 over 80.

"People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure", Whelton said. "This amounts to 4.2 million people, based on the USA population".

"We're recognizing that blood pressures that we in the past thought were normal or so-called "pre-hypertensive" actually placed the patient at significant risk for heart disease and death and disability", said Robert M. Carey, co-chairman of the group that produced the new report.

Dr. Tom Frieden, president and CEO of the Resolve to Save Lives campaign, said that "the new guidelines clearly state treatment with medicine should begin if a patient reaches 140/90, an important piece of clarity in an area that has experienced much debate". They were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies.


Concerns about those side effects, as well as the fact that the close monitoring seen in a clinical trial is hard to replicate, led the AHA, ACC and other groups to select the 130 systolic blood pressure target.

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