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New guidelines mean millions more could have hypertension

A patient has her blood pressure checked by

A patient has her blood pressure checked by a registered nurse in Plainfield, Vt. in 2013. New medical guidelines announced Monday, Nov. 13, 2017, lower the threshold for high blood pressure. Credit: AP / Toby Talbot

Heart experts from the nation’s leading health organizations redefined hypertension Monday in new guidelines that will dramatically boost the number of people considered to have high blood pressure.

The new guidelines indicate that hypertension begins at 130/80, rather than 140/90 as emphasized by previous recommendations. The change is designed to help drive down rates of heart attack, stroke and heart failure — conditions that have high blood pressure at their core.

Doctors from the American Heart Association and the American College of Cardiology updated the guidelines Monday, and in so doing caused an immediate increase in the number of people believed to have hypertension, a disorder long called a silent killer because its symptoms are so subtle.

The affected population is expected to jump from 72 million Americans to 103 million, nearly one-third of the U.S. population.

More sobering, the new guidelines affect a significant proportion of people under age 45. The number of men with hypertension in that age group is expected to triple; the number of women with the diagnosis will likely double.

The good news is that doctors expect the new guidelines will help decrease mortality from heart disease, which remains the number-one killer in the United States.

The new recommendations, the first in more than a decade, are considered landmark and comprehensive because they are based on exhaustive research sponsored by the National Institutes of Health.

“This is a big deal and it’s about time. These guidelines were in the making for quite a while,” said Dr. Allen Jeremias, director of interventional cardiology research and associate director of the cardiac catheterization laboratory at St. Francis Hospital, The Heart Center in Roslyn.

Much of the scientific data on which the new guidelines were crafted come from a large clinical study of nearly 10,000 people who participated in the Systolic Blood Pressure Intervention Trial, known as SPRINT. That clinical research was sponsored in part by the National Heart, Lung and Blood Institute.

The study was designed to determine the best way to treat blood pressure in adults 50 or over with hypertension who are at high risk of heart disease. The study revealed that keeping systolic blood pressure lower than 120 decreased the risk of cardiovascular and kidney diseases.

Systolic pressure, the upper number in the fraction, defines the force on blood vessels as the heart contracts in its characteristic lub-dub rhythm. The lower number is the diastolic, which defines the pressure on the heart in its relaxation mode between each beat.

Long Island doctors applauded the updated rules.

“Managing high blood pressure is a lifelong process, not a one-time event,” said Dr. Stacey Rosen, a cardiologist and vice president of women’s health for the Northwell Health System.

She said at 130/80, patients would be subject to lifestyle changes such as weight management and dietary improvement. If those measures fail to bring down the pressure, only then would doctors consider medication.

People with elevated blood pressure, 140/90 and above, would be subject to drug therapy, especially when their risk for a heart attack is determined to be greater than 10 percent, according to the guidelines.

The guidelines set new categories and get rid of “prehypertension”:

  • Normal: Under 120 over 80
  • Elevated: Top number 120-129 and bottom less than 80
  • Stage 1 hypertension: Top of 130-139 or bottom of 80-89
  • Stage 2 hypertension: Top at least 140 or bottom at least 90.
  • That means 46 percent of U.S. adults have high pressure (stages 1 or 2) versus 32 percent under the old levels.

Source: AP