New Blood Pressure Guidelines – How Will The New Definition Of Hypertension Affect People?

New Definition of Hypertension and Classification of Blood Pressure

The American College of Cardiology/American Heart Association (ACC/AHA) approved new clinical practice guidelines for the classification and treatment of high blood pressure in October 2017. 

Blood pressure is categorized as being normal, elevated, stage I or stage 2 hypertension. These categories help healthcare providers to determine a patient’s risk is for developing cardiovascular disease. This new practice guideline defines hypertension (HTN) as systolic blood pressure (SBP) > 130 mmHg or diastolic blood pressure (DBP) > 80 mmHg.  Previous JNC 7 guidelines classified hypertension as SBP > 140 mmHg or DBP > 90 mmHg. The rationale for this change stems from many meta-analyses that show that people with blood pressures of 130-139/85-89 have an increased risk of having a stroke or coronary heart disease compare to people with a blood pressure less than 130/84. Therefore, there is a need to identify more people with hypertension in order to prevent cardiovascular disease.

What Does This New Definition of Hypertension Mean?

In the JNC 7 guideline, it was estimated that 32% of the overall population had hypertension based on SBP/DBP > 140/90. Using the new guideline definition of SBP/DBP > 130/80, 46% of the population has hypertension. This accounts for roughly an additionally 45 million people. Those who were once told that their blood pressure was just a little high and could be managed with just weight loss, a healthy diet, sodium reduction, and physical activity are now going to be told they need to start taking blood pressure lowering medications. These numbers were taken from 9623 participants in NHANES 2011-2014 and adjusted to the U.S. adult population.

Dangers of Hypertension

Hypertension is often called the ‘silent killer’ because many  people live with high blood pressure without even realizing it. However, it is one of the major risk factors for developing a heart attack, stroke, heart failure, kidney disease, vision loss, chest pain, peripheral artery disease and other health complications. It is also one of the leading causes of death in the United States.

New Goals of Hypertension

New treatment goals for blood pressure is now SBP/DBP of <130/80 mmHg. The new guidelines recommend that regardless of blood pressure a healthy lifestyle should be promoted and maintained which may include lifestyle changes such as diet, regular exercise, weight loss, sodium reduction, and or potassium supplementation. 

If blood pressure is >130/80 mmHg, the risk of any cardiovascular event or disease should be assessed by a healthcare provider before starting blood-pressure lowering medications. Primary antihypertensive medications include thiazide or thiazide-type diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers.

My blood pressure was elevated and NOW I HAVE HYPERTENSION?

It’s important to realize that the term hypertension is a category to which treatment or some type of intervention should be started. Yes, it may sound scary and it may actually be scary. However, almost half the population is also living with hypertension just like you and there are effective ways to lower blood pressure. 

How Can I Lower My Blood Pressure?

Eat a well-balanced, low-salt diet: This includes foods such as fruits, vegetables, whole-grains, low-fat dairy products, skinless poultry and fish, nuts and legumes. It is important to limit salt, sweets, sugary beverages and red meats.

Limit alcohol consumption: Alcohol should only be consumed in moderation. Drinking too much can raise your blood pressure.

Increase potassium intake: Increased dietary potassium and consumption of fruits and vegetables lower the risk of stroke. Potassium intake lowers BP in adult patients who consume too much sodium and in African Americans. Increasing potassium intake is recommended for adults with elevated BP or hypertension who do not have chronic kidney disease or are taking drugs that increase potassium levels.

Enjoy regular physical activity: The American Heart Association recommends 150 minutes of moderate-intensity aerobic activity per week. This can mean walking around the block for 30 minutes most days of the week.

Maintain a healthy weight: Being overweight puts a strain on your heart. The heart’s muscles have to work harder to pump enough blood to the rest of your body. This can lead to not only high blood pressure but all the other health threats that come along with it. It’s important to maintain a healthy weight. Even a little weight loss can improve health. 

Work with your doctor: Your doctor will assess your risk for a stroke, heart attack or death and create a plan to lower these risks. Management of high blood pressure includes lifestyle changes and medications.

Resources and References

ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, 2017

American Heart Association