130 is the new high!

Now almost half of the US adult population has high blood pressure, according to updated hypertension guidelines developed by the American Heart Association (AHA) and the American College of Cardiology which were presented at the AHA’s 2017 Scientific Sessions on 14th November. The guidelines, which are the first comprehensive new high blood pressure guidelines in over a decade, lower the threshold for high blood pressure to 130/80 mm Hg, rather than 140/90 mm Hg.

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With the previous definition, 1 in 3 US adults were defined as having high blood pressure (32%). The new guidelines will result in 46% of the US adult population having high blood pressure or hypertension. However, there will only be a small increase in the number of US adults who will require anti-hypertensive medication, according to the authors. These guidelines are designed to help individuals identify and address the potentially deadly condition much earlier.

In addition to the newly-updated threshold, the guidelines emphasise the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of 2-3 readings on at least 2 different occasions.

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. Patients 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.

The new guidelines were developed by the American Heart Association, American College of Cardiology and 9 other health professional organisations. They were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies.

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 2 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 psycho-social stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.



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