What Do The New Blood Pressure Guidelines Mean For You?

What Do The New Blood Pressure Guidelines Mean For You?
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Valentin Fuster, MD, PhD Physician-in-Chief The Mount Sinai Hospital Director of Mount Sinai Heart

New U.S. guidelines for the detection and treatment of high blood pressure will result in many more Americans being diagnosed with this common yet potentially life-threatening health condition. What does this change mean for you? At more than 100 pages, even a summary of the guidelines is difficult to digest, so here are a few points to help you make sense of them.

What Is High Blood Pressure?

High blood pressure occurs when the force of the blood flowing through your blood vessels is higher than normal. Also called hypertension, high blood pressure can damage the vessels, leading to heart attacks, strokes, kidney disease, and other serious health threats. It is a major risk factor for cardiovascular disease, which, as the leading cause of death worldwide, kills 17.7 million people annually.

The New Guidelines

In November, the American College of Cardiology and the American Heart Association jointly issued new guidelines on high blood pressure—the first update in nearly 15 years. The previous official guidelines, published in 2003, considered hypertension to be equal to or greater than 140/90, whereas they now define high blood pressure as 130/80 or greater—a substantial drop.

The top number of the measurement (systolic) indicates the amount of pressure against artery walls when the heart contracts, while the bottom number (diastolic) refers to the pressure when the heart is resting between beats.

With this change in diagnostic criteria, nearly half of the adult population in the United States will have high blood pressure. The good news is that most people with high blood pressure can control it through lifestyle changes or medication. But the first step to proper treatment is learning whether you have it. Hypertension usually causes no symptoms, so the only way to be sure is to have your blood pressure checked.

Should You Seek Treatment?

If you have been tested, and have a blood pressure of 130/80 or higher, you should probably be treated, especially if you already have a risk factor for cardiovascular disease, such as high cholesterol or smoking; have a serious condition like diabetes or chronic kidney disease; or are 65 or older.

How Do We Treat High Blood Pressure?

Many people can lower their blood pressure to a healthy level through lifestyle changes alone, like decreasing salt intake, losing weight, and minimizing stress. If that is not effective, treatment with prescription blood pressure medication is necessary.

When it comes to controlling high blood pressure, it is crucial that the treatment be tailored to the individual. Ideally, blood pressure should be below 130/80. But not everyone will be able to reach that goal or tolerate the level of medication needed to achieve it. For example, if you have a pressure of 160/90, you might be able to reach only 140/90 before you faint or suffer side effects like dizziness or nausea. Your doctor should work with you to lower your blood pressure, but only as far as you can tolerate it.

A Word of Caution

The new guidelines are not without controversy. In addition to revising the definition of “high” blood pressure, they have added an intermediate category called “elevated,” which is described as 120 to 129 over less than 80, and replaces the category “prehypertension.”

This “elevated” category is confusing to many people, and may lead to patients lowering their blood pressure too far. Since the guidelines were released, I have received calls from a number of patients whose blood pressure was already well controlled, but they had taken steps to reduce it below 120/80 and were fainting, a danger that can occur when blood pressure drops too low. That is why it is important to work with your doctor to determine the level that is right for you.

Know Your Numbers and Take Action

An important issue that the new guidelines do not emphasize enough is the need for increased public awareness of high blood pressure. Many people with hypertension don’t know they have it, and even among those who are identified and treated, only about half reach the blood pressure goals needed to properly control it.

It is essential to educate people, doctors, and communities to identify those with high blood pressure as it is now defined, and treat it properly. Doing so could help millions of people lower their risk for heart disease, stroke, and other devastating conditions, and enjoy longer, healthier lives.

Why not start with yourself? Please have your blood pressure checked at least once a year to determine whether it is high. If it is too high, you should go to a doctor who will work with you to control it through lifestyle changes or medication best suited to your situation.

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