New AHA/ACC guidelines redefine high blood pressure as 130/80 mm Hg

Leslie Hanson
November 14, 2017

The best way to deal with it is by exercising more, eating a diet low in sodium while restricting alcohol and lowering stress. A healthier diet and more exercise, unsurprisingly, are the primary recommendations for those who fall into the new category of stage 1 hypertension, previously called "pre-hypertension" or "high-normal blood pressure", said Paul Whelton, chair of global public health at the Tulane University School of Public Health and lead author of the guidelines.

The changes are expected to drastically impact adult Americans: revising the hypertension threshold downward will increase the percent of USA adults living with high blood pressure from 32 percent to 46 percent - almost half of the adult population.

High blood pressure should be treated earlier with lifestyle changes and in some patients with medication - at 130/80 mm Hg rather than 140/90 - according to the first comprehensive new high blood pressure guidelines in more than a decade.

Data from SPRINT, which was also used in the new meta-analyses that were done for the guidelines, supports the lower blood pressure goal of 130/80 mm Hg for adults, including adults aged 65 years and older in institutionalized ambulatory, community-living settings, according to MacLaughlin. The impact of the new guidelines is expected to be greatest among younger people.

This level is classified as Stage 2 hypertension under the new guidelines. The bottom number refers to your blood pressure when your heart muscle is between beats.

The new guidelines incorporate data from the Systolic Blood Pressure Intervention Trial (SPRINT), which was a large, randomized controlled trial created to assess the impact of more aggressive versus standard blood pressure goals on hard cardiovascular outcomes.

The guidelines, also endorsed by the American College of Cardiology and 11 other organizations, do not change the definition of normal blood pressure as 120/80 or lower.

"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. Damage to the inside of arteries and other blood vessels can grow over time, and rates of hypertension increase with age.

The study that prompted these changes found that over a three-year period, there were 243 "events" - strokes, heart attacks, and cardiovascular deaths - in a group of 4,678 people who achieved a systolic blood pressure of 120 through higher doses of medication.

For the past 14 years, high blood pressure has been defined as 140/90, and approximately one in every three people in the USA are now diagnosed under this measurement. But there will only be a small increase in the number of USA adults who will require medication, the authors of the guidelines said. "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".

"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. It's known as a "silent killer" because often there are no symptoms.

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