Highlights
- High blood pressure is now defined as readings of 130 mm Hg and higher for the systolic blood pressure measurement, or readings of 80 and higher for the diastolic measurement. That is a change from the old definition of 140/90 and higher, reflecting complications that can occur at those lower numbers.
- In the first update to comprehensive U.S. guidelines on blood pressure detection and treatment since 2003, the category of prehypertension is eliminated.
- While about 14 percent more people will be diagnosed with high blood pressure and counseled about lifestyle changes, there will only be a small increase in those who will be prescribed medication.
- By lowering the definition of high blood pressure, the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension.
Embargoed until 12:30 p.m. PT / 3:30 p.m. ET Monday, Nov. 13, 2017
ANAHEIM, California, Nov. 13, 2017 — High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – according to the first comprehensive new high blood pressure guidelines in more than a decade. The guidelines are being published by the American Heart Association (AHA) and the American College of Cardiology (ACC) for detection, prevention, management and treatment of high blood pressure.
The guidelines were presented today at the Association’s 2017 Scientific Sessions conference in Anaheim, the premier global cardiovascular science meeting for the exchange of the latest advances in cardiovascular science for researchers and clinicians.
Rather than 1 in 3 U.S. adults having high blood pressure (32 percent) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, or hypertension. However, there will only be a small increase in the number of U.S. adults who will require antihypertensive medication, authors said. These guidelines, the first update to offer comprehensive guidance to doctors on managing adults with high blood pressure since 2003, are designed to help people address the potentially deadly condition much earlier.
The new guidelines stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions, the authors said.
High blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking. It’s known as the “silent killer” because often there are no symptoms, despite its role in significantly increasing the risk for heart disease and stroke.
Paul K. Whelton, M.B., M.D., M.Sc., lead author of the guidelines published in the American Heart Association journal, Hypertension and the Journal of the American College of Cardiology, noted the dangers of blood pressure levels between 130-139/80-89 mm Hg.
“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” he said. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”
Blood pressure categories in the new guideline are:
Normal: Less than 120/80 mm Hg;
Elevated: Top number (systolic) between 120-129 and bottom number (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: Top number over 180 and/or bottom number over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
The new guidelines eliminate the category of prehypertension, which was used for blood pressures with a top number (systolic) between 120-139 mm Hg or a bottom number (diastolic) between 80-89 mm Hg. People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).
Previous guidelines classified 140/90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines.
The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45 according to the report.
Damage to blood vessels begins soon after blood pressure is elevated, said Whelton, who is the Show Chwan professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans. “If you’re only going to focus on events, that ignores the process when it’s beginning. Risk is already going up as you get into your 40s.”
The guidelines stress the importance of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications.
“People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure,” Whelton said. “Masked hypertension is more sinister and very important to recognize because these people seem to have a similar risk as those with sustained high blood pressure.”
Other changes in the new guideline include:
Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.
The new guidelines were developed by the American Heart Association, American College of Cardiology and nine other health professional organizations. They were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies. The guidelines underwent a careful systematic review and approval process. Each recommendation is classified by the strength (class) of the recommendation followed by the level of evidence supporting the recommendation. Recommendations are classified I or II, with class III indicating no benefit or harm. The level of evidence signifies the quality of evidence. Levels A, B, and C-LD denote evidence gathered from scientific studies, while level C-EO contains evidence from expert opinion.
The new guidelines are the successor to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7), issued in 2003 and overseen by the National Heart, Lung, and Blood Institute (NHLBI). In 2013, the NHLBI asked the AHA and ACC to continue the management of guideline preparation for hypertension and other cardiovascular risk factors.
Co-authors are Robert M. Carey, M.D., vice chair of the writing committee; Wilbert S. Aranow, M.D.; Donald E. Casey, Jr., M.D., M.P.H., M.B.A.; Karen J. Collins, M.B.A.; Cheryl Dennison Himmelfarb, R.N., A.N.P., Ph.D.; Sondra M. DePalma, M.H.S., P.A.-C, C.L.S.; Samuel Gidding, M.D.; Kenneth A. Jamerson, M.D.; Daniel W. Jones, M.D.; Eric J. MacLaughlin, Pharm.D.; Paul Muntner, Ph.D.; Bruce Ovbiagele, M.D., M.Sc., M.A.S.; Sidney C. Smith, Jr., M.D.; Crystal C. Spencer, J.D.; Randall S. Stafford, M.D., Ph.D.; Sandra J. Taler, M.D.; Randal J. Thomas, M.D., M.S.; Kim A. Williams, Sr, M.D.; Jeff D Williamson, M.D., M.H.S. and Jackson T. Wright, Jr., M.D., Ph.D., on behalf of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Author disclosures and our collaborating organization partners are listed online and in the appendix to the manuscript.
Additional Resources:
- Downloadablemultimedia includingHD interviews with Dr. Paul Whelton and Dr. Joaquin Cigarroais on the right column of the release link: https://newsroom.heart.org/news/high-blood-pressure-redefined-for-first-time-in-14-years-130-is-the-new-high?preview=92ced1fad41b056df4e6ae0f73a09db4
- Additional videos will be posted here
- Spanish Release
- After embargo lifts, please view the manuscript online at:
- Commentary by AHA president John Warner, M.D. is available at https://healthmetrics.heart.org/commentary/
- Data visualization of the impact of the new guidelines is available at https://healthmetrics.heart.org/data-visualization/
- Find high blood pressure management resources at www.heart.org/hbp.
- Check.Change.Control. Calculator for Consumers www.heart.org/ccccalculator
- ACVD Risk calculator for healthcare professionals http://static.heart.org/riskcalc/app/index.html#!/baseline-risk
- Follow AHA/ASA news on Twitter @HeartNews
###
The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical and device manufacturers and health insurance providers are available at www.heart.org/corporatefunding.
About the American Heart Association
The American Heart Association, the world’s leading voluntary health organization devoted to fighting cardiovascular disease, is devoted to saving people from heart disease and stroke – the twoleading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visitheart.orgor call any of our offices around the country. Follow us on Facebook and Twitter.
About the American College of Cardiology
The American College of Cardiology is the professional home for the entire cardiovascular care team. The mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit acc.org or follow @ACCinTouch on Twitter and Facebook.
For Media Inquiries: 214-706-1173
AHA - Maggie Francis: 214-706-1382; maggie.francis@heart.org
ACC – Nicole Napoli: 202-669-1465; nnapoli@acc.org
For Public Inquiries: 1-800-AHA-USA1 (242-8721)
heart.org and strokeassociation.org
As an expert in cardiovascular health and hypertension, I bring a wealth of knowledge to shed light on the groundbreaking updates in blood pressure guidelines presented by the American Heart Association (AHA) and the American College of Cardiology (ACC). With a deep understanding of the subject matter, I'll delve into the key concepts highlighted in the provided article.
Firstly, the article discusses a significant shift in the definition of high blood pressure. Previously, readings of 140/90 mm Hg and higher were considered indicative of hypertension. However, the new guidelines redefine high blood pressure as readings of 130/80 mm Hg and above for systolic and diastolic measurements, respectively. This change reflects a more proactive approach to address complications associated with lower blood pressure levels.
The elimination of the prehypertension category is another crucial update. Individuals who would have fallen into the prehypertension range, with systolic readings between 120-139 mm Hg or diastolic readings between 80-89 mm Hg, are now categorized as either having Elevated blood pressure (120-129 and less than 80) or Stage 1 hypertension (130-139 or 80-89).
The article emphasizes the importance of accurate blood pressure measurement techniques. It advocates for using the average of two to three readings on at least two different occasions to determine blood pressure levels accurately.
One notable aspect of the new guidelines is the emphasis on earlier intervention through lifestyle changes and, in some cases, medication. The article suggests that by lowering the threshold for high blood pressure, healthcare professionals can intervene sooner, potentially preventing further increases in blood pressure and related complications.
The impact of these guidelines is anticipated to be significant, particularly among younger individuals. The prevalence of high blood pressure is expected to triple among men under 45 and double among women under 45. This underscores the importance of addressing hypertension early in life to mitigate the risk of cardiovascular complications.
Furthermore, the article touches on the importance of home blood pressure monitoring using validated devices. This approach helps identify "white-coat hypertension" and "masked hypertension," where blood pressure readings may be elevated or normal in clinical settings but differ in everyday life.
In terms of treatment, the guidelines recommend medication for Stage I hypertension only if a patient has experienced a cardiovascular event or is at high risk based on various factors such as age, diabetes, or chronic kidney disease.
The development of these guidelines involved a thorough review of over 900 published studies by a panel of 21 scientists and health experts. The guidelines underwent a systematic review and approval process, with recommendations classified based on the strength and level of evidence supporting them.
In summary, these new guidelines represent a significant paradigm shift in the approach to blood pressure management, advocating for earlier intervention, accurate measurement techniques, and a comprehensive understanding of risk factors associated with hypertension.
