Olympic Internal Medicine Blog: New Blood Pressure Guidelines
As many of you may have heard, a new guideline for high blood pressure was recently (November 2017) released by the American College of Cardiology and American Heart Association (ACC/AHA). The big news grabbing part of the guideline was the change in definition of hypertension, down to anything over 130/80, which means nearly 50% of the U.S. population now is considered as having hypertension, and 90% of adults will have hypertension by age 85.
A new “normal” blood pressure
Furthermore, “normal” blood pressure is defined as under 120/80, however this is not a treatment target. This is a stark contrast to the previous guideline from 2014 (called JNC 8), which recommended raising blood pressure targets in those over age 60 to 150/90, for almost everyone else the goal blood pressure was under 140/90.
- New Hypertension definition: anything over 130/80
- New Normal Blood Pressure definition: under 120/80
One fear is that because of the new guideline, too many people will be put on medication. However the guideline does more than just lower the definition of hypertension, there are also more blood pressure guidelines put in place for when medication is needed.
- Medication is only recommended as initial therapy for most people with blood pressure over 140/90.
- Medication for hypertension in the 130-140 range applies only to folks with
- Patients with an elevated risk of heart attack and stroke – which is more than a 10% risk in the next 10 years
- With diabetes or chronic kidney disease
- Patients with persistent hypertension despite attempts at lifestyle change.
Increased emphasis on correctly measuring blood pressure
Including increased reliance on home blood pressure readings. If using home readings, the equivalent target ranges are 5 points lower than in the office (so a home reading of 135/85 is considered the same as an office reading of 140/90). Elevated readings should be confirmed on multiple occasions as well, before starting treatment, to avoid over treatment.
Lifestyle changes are the first line of therapy
For folks with hypertension in the 130-140 range and less than 10% heart attack or stroke risk, diet and exercise modifications are the initial treatment, not medication. Here are a few lifestyle changes that most doctors would recommend:
- Less than 1500mg of sodium per day
- Increased potassium intake
- Heart-healthy diet such as the DASH diet
- 1 drink per day for women
- Less than 2 drinks per day for men
Exercise regularly & obtain a healthy weight
- 90-150 minutes per week
The main study that prompted this new guideline found that using lower blood pressure targets does result in more side effects, including passing out, falls, electrolyte abnormalities, and kidney injury, but the benefit is significantly decreased numbers of heart attacks, strokes, and overall deaths (around 25% less in fact).
This held true even in study patients over 75 years old. That being said, the guideline includes this disclaimer: “For older adults (≥65 years of age) with hypertension and a high burden of comorbidity and/or limited life expectancy, clinical judgment. . . is reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs.” Which translated – means that internal medicine doctors are left to their own interpretations of what is best for the patient.
Still have Questions?
Our healthcare providers are here to help you understand how these new blood pressure guidelines will effect your hypertension treatment plan. Contact us to learn more about these guideline changes, or to schedule an appointment.