On Nov. 13, 2017, two leading health groups, the American Heart Association (AHA) and the American College of Cardiology (ACC), jointly released new guidelines that group more individuals into the category of elevated or high blood pressure.
Normal blood pressure is still any reading less than 120 over 80, or less than 120 millimeters of mercury (mmHg) of systolic pressure and less than 80 mmHg of diastolic pressure. Under the new guidelines, blood pressure readings above that now are considered elevated or high. As the AHA/ACC note, 46 percent of U.S. adults now can be classified as having high blood pressure, up from 32 percent under the previous guidelines.
This issue isn’t one to be taken lightly. But it’s important to note that there aren’t suddenly millions of people who now have high blood pressure, or hypertension, that they didn’t have before. These new guidelines are meant to raise awareness of controlling blood pressure before it becomes a serious health risk.
What’s changed in the new blood pressure guidelines?
The new guidelines eliminate the old “prehypertension” category, which is when doctors would advise patients that their blood pressure was higher than normal but not quite enough to be classified as hypertension. The new guidelines start stage 1 and stage 2 high blood pressure at lower levels.
Here’s how the numbers break down:
- Elevated blood pressure: 120 to 129 mmHg systolic; less than 80 mmHg diastolic
- Stage 1 high blood pressure: 130 to 139 mmHg systolic; 80 to 89 mmHg diastolic
- Stage 2 high blood pressure: 140 or above mmHg systolic; 90 or above mmHg diastolic
It’s important to remember that this is not new information. We’ve known for many years that optimal blood pressure is less than 120 over 80, and that hasn’t changed. The new guidelines simply recognize that doctors and patients weren’t addressing the problem early enough. High blood pressure is a known risk factor for a number of dangerous conditions, including heart attacks, strokes and even Alzheimer’s disease, and the risk of diseases that are linked to high blood pressure doubles with a systolic pressure of 130 compared to 120. Lowering your systolic blood pressure just from 140 to 130 can mean a 15 to 20 percent reduction of your risk for heart disease.
What the new blood pressure guidelines don’t say
Despite the expected increase in hypertension diagnoses, the AHA/ACC’s new guidelines are clear about not advocating for a huge increase in the number of people who take medications to lower their blood pressure. If we’re too aggressive in prescribing medications, especially for people who haven’t hit the higher stages of blood pressure, we could risk overtreating their disease. Blood pressure medications can cause side effects, such as fatigue, headaches, nausea or dizziness. That last one is a particular problem among older people, who could be at risk for falling. Treating blood pressure with medications always involves balancing the medications’ benefits against their potential for harm. And in my opinion, for these people on the lower end of the spectrum, beta blockers, diuretics and other medications that reduce blood pressure can do more harm than good.
There are other medications we can use that are less harmful for patients who need just a little help controlling their blood pressure. And, of course, we’ll have to continue studying what types of drugs patients are receiving, so that we balance the benefits of treatment with the potential harm of overtreatment.
I believe the AHA/ACC’s new blood pressure guidelines should start blood pressure management conversations between patients and their healthcare providers. Being more aware of and aggressively managing lifestyle factors that contribute to high blood pressure, especially early on, is better for everyone involved.
Tips to get your blood pressure under control
I know there are people out there reading this and thinking, “Oh, great—another doctor talking to me about diet, exercise and losing weight.” And it’s true that these factors are critical in managing blood pressure. But what needs to change is how doctors talk to patients about these factors.
More than any other time in human history, we live in an era of self-empowered health care. For example, you don’t need a doctor to tell you you’re eating too much salt, which can cause blood pressure to rise. There are great apps out there, such as MyFitnessPal, that can tell you how much salt is in your diet. If you’re getting more than 2 or 2.5 grams of salt per day, you probably should eliminate high-sodium foods, including canned foods or fast food. Reducing your sodium intake to below these levels could lower your blood pressure four to seven points.
You also can track your activity levels to see if you need to work in another trip to the gym per week or start an exercise plan if you aren’t physically active. Exercising for 30 minutes per day most days of the week can lower your blood pressure two to three points, and losing even 10 pounds of extra weight can lower blood pressure by three to five points.
I often talk to patients about medications that can increase blood pressure. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are common culprits. NSAIDs have been clinically proven to increase blood pressure in people with normal and high blood pressure because they cause the kidneys to hold on to salt for too long. Not only can taking NSAIDs raise your blood pressure by two to three points, but they also can lower the effectiveness of any blood pressure medication your doctor may prescribe.
Another factor I encourage patients to control is sleep apnea, which has been linked to high blood pressure and a host of other cardiovascular problems. Doctors traditionally have ordered a sleep study if they believe a patient has sleep apnea, and we offer those in our Sleep Center. But you also may be a good candidate for a home sleep test.
Related reading: Putting Sleep Apnea to Bed
Lastly, I encourage everyone to measure their blood pressure on a regular basis, especially outside the doctor’s office. The stress of a doctor’s visit can cause people’s blood pressure to read abnormally high, and it might be lower when you measure it at your local pharmacy or at home. The AHA recommends cuffs used on the biceps (upper arm) for more reliable readings, and the association provides an easy-to-use calculator for understanding what those numbers mean. This is especially important for older adults, who are particularly at risk for high blood pressure and who have had higher target numbers under past guidelines.
Related reading: How to monitor your blood pressure at home
I’m cautiously optimistic about what the new AHA/ACC blood pressure guidelines can do to help. But just as the guidelines didn’t suddenly create millions of people with high blood pressure, they can’t suddenly create new doctors, nurses and other healthcare professionals to solve the problem. That means it’s up to everyone to take responsibility for their blood pressure and risk factors.
Know your blood pressure numbers. Talk to your doctor about how to lower those numbers if they’re high. Take ownership of the situation, because you can have a real and measurable effect on your future health.
Request an appointment with one of our cardiologists if you need help lowering your blood pressure.
