New Blood Pressure Guidelines: Could You Have High Blood Pressure Now?
In November, the American Heart Association (AHA) and the American College of Cardiology (ACC), released a new set of blood pressure guidelines, the first since 2003. The guidelines are based on more than 900 published studies and were written by a group of 21 scientists and health experts in conjunction with nine other health professional organizations.
According to the ACC, the new guidelines include updated information from studies on blood pressure-related risk of cardiovascular disease, ambulatory blood-pressure monitoring, home blood-pressure monitoring, the blood-pressure level at which medication should be introduced, the goals of treatment, and ways to improve the treatment and control of hypertension, among others.
Given all that, it seems like the time for new guidelines was nigh but what are they are why are they controversial?
Old Guidelines vs. New Guidelines
The good news is that the range of blood pressure readings categorized as normal has remained the same. If your blood pressure is 120/80 or less, you are in the normal range.
The major change between the old and guidelines is that the definition of what constitutes high blood pressure has been lowered.
Readings of 120-139/80-89 used to be considered “prehypertensive,” but under the new guidelines these readings are considered Stage 1 hypertension. The prehypertensive category has been done away with and replaced with an “elevated” category, for readings of 120-129/<80.
The old Stage 1 hypertension category of 140-159/90-99 is now basically Stage 2 hypertension. The old Stage 2 category of 160+/100+ is now in the realm of “hypertensive crisis” with readings of 180+/120+.
So, to be clear, following are the new categories as detailed by the American College of Cardiology:
- Normal: Less than 120/80 mm Hg
- Elevated: Systolic between 120-129 and diastolic less than 80
- Stage 1: Systolic between 130-139 or diastolic between 80-89
- Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg
- Hypertensive crisis: Systolic over 180 and/or diastolic over 120
According to the ACC, those who fall in the “hypertensive crisis” category would need to promptly change medication if there are no other indications of any problems or be immediately hospitalized if there are signs of organ damage.
Why are the guidelines controversial?
On an individual level, those who were considered prehypertensive on Nov. 12, 2017, the following day have Stage 1 hypertension, according to the new guidelines. And it gets worse from there: Those who were Stage 1 are now at Stage 2 and those who were at Stage 2 could now be in hypertensive crisis.
The new guidelines have caused almost half of the adult U.S. population to be categorized as having high blood pressure, notes the ACC. The change is expected to triple the occurrence of high blood pressure among men aged 45 and younger and double the number of women in the same age range.
The guidelines also specify that intervention to treat high blood pressure—including lifestyle changes and medication—should begin at readings of 130/80 rather than the previous 140/90 but then go on to note that, “only a small increase is expected in the number of adults requiring antihypertensive medication.”
Therein lies another part of the controversy, as a number of critics believe that some consequences of the guideline changes will be overtreatment and more Americans on anti-hypertensive drugs.
Another shortfall of the new guidelines is the expectation that people of vastly different ages should have the same blood pressure goal. In “Redefining Hypertension—Assessing the New Blood Pressure Guidelines,” published in the New England Journal of Medicine, Dr. George Bakris and Dr. Matthew Sorrentino, explain that the new guidelines recommend that 30-year-olds and 80-year-olds endeavor to have the same blood pressure goal. “Achieving that goal is impossible for many people, especially those with poor vascular compliance,” they assert.
What does this mean for you?
According to Dr. Kevin Campbell, a cardiologist and author of “New Blood Pressure Guidelines: What Every American Should Know,” the new guidelines “will have a positive impact on care because they will force physicians to identify patients and intervene earlier.” He noted that the new guidelines also were presented with new treatment options.
For those who fall into the “elevated” category, lifestyle changes—such as improving diet, exercising regularly, losing weight, and cutting salt intake—may be enough to keep blood pressure in check.
Patients with Stage 1 hypertension will have treatments options based on risk factors. Stage 1 patients with average risk will be educated on and encouraged to follow a trial period of lifestyle modifications and will then be closely monitored. If the lifestyle changes alone don’t control blood pressure, medication may be warranted.
Those with an increased risk—a family history of high blood pressure, high cholesterol or diabetes, for example—will most likely be prescribed medication in addition to the recommended lifestyle changes. Those in the Stage 1 category, who have had a previous cardiac event such as a heart attack or stroke, should also expect to be prescribed medication if they aren’t currently on medication.
Those with Stage 2 hypertension should be prescribed medication at the time of the initial diagnosis. Positive lifestyle changes are always recommended for patients with hypertension no matter the risk factors or the categorization.
Those in the hypertensive crisis range should contact their doctor immediately and even seek emergency treatment, if necessary.
How do you know if you have hypertension?
Although the blood pressure monitoring equipment at retail pharmacies is helpful, a reading from one is not enough for a definitive diagnosis.
A visit to any doctor, or even sometimes your dentist, begins with a check of your vital signs, including your blood pressure. If your initial blood pressure reading is higher than the normal range, your doctor most likely will want to take several readings over a span of time or he/she may want you to monitor your blood pressure by taking it at home.
One single high reading does not mean you have high blood pressure. There are normal, routine things that can cause your blood pressure to spike including: rushing to your doctor’s appointment, drinking coffee or an energy drink, having a full bladder, sitting with your legs crossed, being cold or even something that doctors call “white coat hypertension,” a high blood pressure reading caused by simply being at the doctor’s office.
If your readings are continuously higher than normal however, your doctor will probably want to put you on a treatment plan, which may consist of lifestyle modifications or lifestyle modifications and medication.
Continue to train as normal or take it easy?
If you have received a diagnosis of hypertension, you might be a little cautious about continuing your training for fear that it may cause a debilitating cardiac event. Think Alberto Salazar, Jim Fixx, Dave McGillivary, Bob Harper. With some minor changes, you should actually continue to exercise as it can help lower blood pressure.
The article “How to Run with High Blood Pressure,” on Livestrong.com details six precautions to take if you are a runner with high blood pressure.
- Get the green light from your doctor. If you are new to exercising or want to continue to run, bike, swim, etc., run it by your doctor first.
- Don’t skip the warm-up. The AHA recommends a 10-minute warm-up before running to allow your heart rate to increase gradually and to allow your body to prepare for the increased demands of running.
- At least 30 minutes at medium speed. The American College of Sports Medicine recommends that 30 minutes of running at a moderate pace is just as effective as more vigorous exercise in lowering blood pressure.
- Take a break. A walk break that is. Walk breaks during a run are perfectly acceptable and can lessen the impact on lower-body joints, particularly if you have some weight to lose. Run for a specific number of minutes and then walk for a specific number of minutes. The ratio is up to you but as your fitness increases, try to shorten the walk breaks or take fewer of them.
- Walk it off. Cool down from your workout with a walk. This allows the heart rate to return to normal gradually. A sharp drop in heart rate can occur if you stop exercising abruptly, which can cause cramping and dizziness.
- Try for three days a week. Three days of exercising per week will improve fitness and possible blood pressure readings. Increase the number of work out days as your fitness level allows.