With new guidelines, more Americans may find they have elevated...

With new guidelines, more Americans may find they have elevated blood pressure. Credit: TNS Dreamstine / Mark Adams

If your last blood pressure check at the doctor’s office didn’t raise concerns, new medical guidelines could change that in 2018.

The mark now considered to be high blood pressure is 130/80, compared with the previous 140/90, under new guidelines released in November by the American Heart Association and the American College of Cardiology.

The shift likely will catch tens of millions of Americans by surprise because they previously got a pass from doctors, according to internal medicine physician Dawn DeWitt in Spokane, Washington. Many of the newly diagnosed likely won’t go on medication but rather will be advised to make lifestyle changes, she said, such as lose weight, stop smoking, and exercise regularly.

“The logic behind the new guidelines is that the sooner high blood pressure is diagnosed and treated, the greater the chance of preventing problems,” said DeWitt, associate dean of clinical education at Washington State University’s Elson S. Floyd College of Medicine.

“They released these new guidelines saying to some degree, all these heart attacks and strokes are, quote, preventable. It’s saying if we treat hypertension better, we can prevent or delay many of these events, a lot of which are either severely debilitating or life-ending, so it’s not a small thing.”

The move also acknowledges that heart disease, strokes, and related conditions are generally a long-term process.

“It’s not like your arteries are perfect one week and the next week, boom, you’ve got a heart attack,” she said. “It takes time. Other than smoking, obesity and hypertension are the two biggest entwined factors for the general population.”

About 85 million adults, or one in three, in the United States have high blood pressure, according to a project of the AHA and American Medical Association called Target BP, which offers support and urges patients to prioritize blood-pressure control.

Obesity is a significant factor toward heart disease, and since the 1970s, rates within the U.S. population in overweight and obese categories have increased significantly, according to DeWitt. Generally, blood pressure increases as people gain weight.

“There’s a general consensus that heart disease and strokes are basically the No.1 killer of Americans, and that’s gotten worse with the obesity epidemic.”

The new blood pressure guidelines have both financial and psychological impacts, she said. The cost could be in lifestyle changes — paying to go to the doctor more, exercise classes, lifestyle coaching, gym memberships. Psychologically, some people who have never had a disease before suddenly are labeled as having hypertension, she said.

“The implications of making that announcement are that overnight millions and millions more Americans would be classified as having hypertension,” DeWitt said. And it could be considered a pre-existing condition, “so in all the uncertainly with Republican health reform, if we went back to a situation where people could be denied health insurance coverage for a pre-existing condition, to have people labeled with hypertension when they weren’t previously labeled, that’s a big crunch.”

Meanwhile, the number of medications available to treat hypertension increased, creating a more complicated landscape today, added DeWitt. “Over half of adults require three or more medications to control blood pressure to 140 over 90,” she said. “At that point, 50 to 60 percent of Americans are rated as uncontrolled by their chart.”

Other contributing factors toward heart disease for some Americans are cholesterol and diabetes. Salt intake is somewhat controversial within the topic, she said. But for some people, reducing salt can make a difference in blood pressure.

“Smoking goes without saying,” she said. “The next implications on the good side is that most people classified with hypertension, they have the option for treatment with lifestyle changes, lose a few pounds, increase exercise, decrease salt and junk food, stop smoking.”


The American Heart Association offers blood pressure information at its website, www.heart.org. It’s also involved in an initiative called Target BP, www.targetbp.org. AHA offers some of the following guidelines.

Your blood pressure is recorded as two numbers:

Systolic blood pressure (the upper number) indicates how much pressure your blood is exerting against your artery walls when the heart beats.

Diastolic blood pressure (the lower number) — indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Normal blood pressure is within the optimal range of less than 120/80. Elevated blood pressure is when readings are consistently ranging from 120 to 129 systolic and less than 80 diastolic.

Hypertension Stage 1 is when blood pressure is consistently ranging from 130 to 139 systolic or 80 to 89 diastolic. At this stage, doctors are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of cardiovascular disease.

Hypertension Stage 2 is when blood pressure is consistently ranging at levels of 140/90 or higher. At this stage, doctors are likely to prescribe a combination of medications and lifestyle changes.

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