by Deborah Horn, DO, MPH, MFOMA
The answers to this question are more complicated than they were a year ago. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) published new guidelines on “hypertension,” or high blood pressure, including changes to the cutoff number for “how high” is high. If you apply these guidelines to the U.S., the number of people with high blood pressure increased overnight from 32 percent to 46 percent based on the new definitions. Also, some individuals were more affected by the new guidelines than others. The number of men between 20 and 44 years of age with high blood pressure tripled, increasing from 11 percent to 30 percent. Are you one of these individuals diagnosed with high blood pressure overnight?
If you followed the media chatter after the release of these guidelines, you probably already know that there is disagreement even among physicians about the proposed changes. Let’s take a look together at the changes in these guidelines and what they mean for you.
Blood pressure is evaluated by taking two numbers. The top number, also called your systolic blood pressure, is the pressure in your arteries when your heart is contracting. The bottom number, also called your diastolic blood pressure, is the pressure in your arteries when your heart is relaxed. Both numbers are equally important and looked at separately.
Based on previous guidelines, “normal” blood pressure is considered less than 120 mmHg of systolic pressure and less than 80mmHg of diastolic pressure. Your doctor may have referred to this as a blood pressure less than 120/80. If your blood pressure falls between 120-139 mmHg systolic or 80-89 mmHg diastolic, you are diagnosed with “prehypertension.” Finally, a blood pressure of greater than or equal to 140 systolic, 90 diastolic is considered high blood pressure or hypertension.
Under the newly-proposed guidelines, a normal blood pressure is still less than 120/80. However, there is no longer a category of “prehypertension.” In fact, this category was broken into
A blood pressure of 120-129 systolic and a normal diastolic blood pressure of less than 80 is considered “elevated blood pressure.” Stage 1 hypertension was redefined as any blood pressure greater than 130 systolic or greater than 80 diastolic. Previously, both of these numbers would have been considered “prehypertension.” This explains why with these new cutoffs, so many more people have a diagnosis of hypertension instead of prehypertension.
In summary, the diagnosis of hypertension was essentially lowered by 10 points for both of your blood pressure numbers. The authors of the proposed changes site studies that demonstrate increased risk of cardiovascular disease at these lower blood pressures as the reason for lowering the threshold for diagnosis.
Even though many major medical organizations have endorsed these new guidelines, there is no consistent agreement among all of your physicians. The American Academy of Family Physicians (AAFP) has not endorsed the new guidelines. They have recommended that family physicians and their patients stick to the last-updated guidelines of the Joint National Committee (JNC) from 2014 called JNC8, which we covered in the beginning of this article.
They indicated their reasons for not endorsing the new guidelines were that they were:
Additionally, the family medicine and internal medicine societies jointly published their own guidelines in January 2017, which are specific to adults older than 60 and conflict with the newly-proposed guidelines.
First and most importantly, if your blood pressure is regularly above 120/80, start a conversation with your healthcare provider. If you choose to follow the new guidelines with your healthcare provider, it may change how early you decide to use medications to control your blood pressure.
Here are the basics to understand and discuss with your physician based on the newly-proposed guidelines:
This is a major change from previous guidelines, where a single medication would have been started first. In addition to medication, what other important actions should you consider taking? In other words, what falls under healthy lifestyle changes?
So how do you calculate your 10-year risk? You use the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator. Go to cvriskcalculator.com.
Answer the questions and the program will give you your risk score. You will need your most recent cholesterol lab results as well as a recent systolic blood pressure number.
This is where most guidelines and healthcare providers can agree. Consider the Top 10 Healthy Lifestyle Changes List on page 54 for ways to tackle increased blood pressure head on!
Top 10 Healthy Lifestyle Changes
It will take several years to see how clinicians respond to these guidelines, to see if they are widely adopted and to eventually change how hypertension is treated. The most important thing is to be an educated patient, ask questions and make decisions together with your healthcare provider. It’s your health, and you need to have a plan that you can agree on and commit to long-term.
About the Author:
Deborah Horn, DO, MPH, MFOMA, is the President of the Obesity Medicine Association and Clinical Assistant Professor in the Department of Surgery at The University of Texas McGovern Medical School at Houston. She is the Medical Director for the UTHealth Center for Obesity Medicine and Metabolic Performance. Dr. Horn was also the recipient of the OAC’s Healthcare Provider Advocate of the Year award – an award given to a healthcare provider who is a tireless advocate for patients, the OAC and the cause of obesity.
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