Guidelines

High Blood Pressure Guidelines (2017)

High blood pressure, also known as hypertension, occurs when the force of blood against the artery walls is too high. High blood pressure affects nearly 1 in 2 adults in the U.S. It is often called the “silent killer” because many people don’t know they have it. Over time, high blood pressure can lead to a heart attack, stroke and other serious conditions.

light bulb What is blood pressure?
Blood pressure is a measure of how hard your blood pushes against your arteries as it moves through your body.
To improve the care of patients with high blood pressure, the American College of Cardiology and American Heart Association task force update guidelines with the hope of better outcomes for people at risk for or living with this condition.

The most recent guidelines, released on Nov. 13, 2017, address how to prevent, screen and manage blood pressure in adults. They are the first full set of guidelines for blood pressure in the U.S. since 2003. The aim is to help patients reduce their risk for getting high blood pressure and improve health outcomes for those already living with it. Below are key points that every patient should know about the update.

New Categories

The guidelines change how blood pressure is defined. (See table.) The new definitions are stricter and will change the category that many patients fall under based on their blood pressure readings.

 Blood Pressure Category
Systolic Blood Pressure
  Diastolic Blood Pressure
 Normal  <120 mm Hg
 And  <80 mm Hg
 Elevated  120-129 mm Hg
 And  <80 mm Hg
 High Blood Pressure
     
     Stage 1
 130-139 mm Hg
 Or  80-89 mm Hg
     Stage 2
 140 mm Hg
 Or  90 mm Hg

For example, blood pressure between 120-139/80-89 mm Hg was defined before as “prehypertension,” and the cutoff for stage 1 high blood pressure was 140/90 mm Hg or higher. Those cutoffs are now lower with stage 1 high blood pressure starting at 130/80 mm Hg. Therefore, patients with a blood pressure between 130-139/80-89 mm Hg now are seen as having stage 1 high blood pressure.

It’s important to note that the new guidelines replace the term “prehypertension” with “elevated” blood pressure. This label covers patients with elevated blood pressure who are at higher risk for developing full-blown high blood pressure.

Treatment

Lifestyle Changes Key

Under the old guidelines, about 3 out of 10 Americans were seen as having high blood pressure. Now, nearly 5 out of 10 Americans qualify as having either stage 1 or stage 2 high blood pressure based on the revised groupings. However, experts note that treatment recommendations are not the same for all patients with high blood pressure.

Experts urge patients with stage 1 high blood pressure at low risk for developing heart disease to adopt healthy lifestyle changes as their first line of treatment. These include:

  • Lose weight if needed and keep a healthy body weight.
  • Eat a healthy diet: Follow the Dietary Approaches to Stop Hypertension (DASH) diet, limit salt and eat potassium-rich foods.
  • Get regular physical activity.
  • Limit alcohol (no more than one drink per day for women, two drinks per day for men).

Role of Medicine

However, lifestyle changes plus medicine are recommended in patients with stage 1 high blood pressure who are at higher risk of heart disease. How is your risk measured? The ASCVD risk calculator is used to assess the chance you will have a heart attack or stroke within the next 10 years. It takes into account:

  • Age
  • Gender
  • Total and HDL (good) cholesterol
  • Systolic blood pressure (the top number)
  • If you smoke or have diabetes

light bulb What is ASCVD? Heart attack and stroke are often caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries.
During your next checkup, talk with your health care professional about your risk for getting heart disease. Also, if you are already being treated for high blood pressure, you may need to intensify your lifestyle changes, medication or both.

Secondary Causes

Experts also stress the importance of treating other issues that can cause high blood pressure, such as kidney disease and drinking too much alcohol. In these cases, it’s important to treat the cause of the issue behind the blood pressure, rather than the blood pressure alone.

Blood Pressure Readings

The new guidelines highlight the need for regular monitoring and correct readings for patients with or at risk of high blood pressure.

Monitoring your blood pressure at home can be useful for patients, especially for those whose blood pressure varies a great deal. For example, patients might have:

  • “White coat hypertension,” which is when patients have high blood pressure during office visits but normal readings at home.
  • “Masked hypertension,” which is when patients have normal readings in the office but elevated blood pressure at home.

Home blood pressure monitoring is especially useful in such patients, as it more accurately reflects a patient’s health and guides more effective treatment.

Questions to Ask

As always, it’s important to talk with your health care professional about your care and treatment. Here are some questions you might ask at your next health visit:

  • I haven’t really been concerned about my blood pressure. It’s always been below 140/90 mm Hg. What’s different now?
  • Will I need to take medicine?
  • I’m taking medicine to lower my cholesterol and have been doing well. Based on the new guidelines, my blood pressure is not controlled. What do I need to do now?
  • How does my risk of heart disease factor into my blood pressure treatment?
  • What lifestyle changes should I make? 
  • How much salt is safe for me to take when I have high blood pressure?
  • What is sodium in terms of amount of salt?
  • Is the salt restriction just related to what I add to my food or what is in my food?
  • How do I use my home BP cuff? How do I know if it is accurate?
  • Do I need to see a dietitian?

Go to CardioSmart.org/HighBP to learn more.