New guidelines adopted by the American College of Cardiology and American Heart Association lower thresholds for high blood pressure. The changes affect millions of Americans. In fact, under the new guidelines nearly 50% of U.S. adults have high blood pressure.
The change in the guidelines should encourage people to start managing their blood pressure sooner. Complications of high blood pressure begin earlier than previously thought. “We're recognizing that blood pressures that we in the past thought were normal or so-called pre-hypertensive actually placed the patient at significant risk for heart disease and death and disability,” said Robert Carey, a professor of medicine at the University of Virginia School of Medicine and co-chair of the group whose report led to the guideline changes.
Bottom line: high blood pressure should be treated earlier with lifestyle changes. And in some patients, as shown in the table below, earlier treatment should also include medication.
New ACC/AHA High Blood Pressure Guidelines
Note: The usual impact of each lifestyle change is a 4-5 mm Hg decrease in SBP and 2-4 mm Hg decrease in DBP; but diet low in sodium, saturated fat, and total fat and increase in fruits, vegetables, and grains may decrease SBP by approximately 11 mm Hg.
Many of the people affected by the new guidelines will be under the age of 45 and appear healthy otherwise. Their mildly elevated blood pressure may not have prompted intervention from health care providers in the past. Under the new guidelines, they will be actively encouraged to make healthy lifestyle changes to keep hypertension at bay.
The narrower thresholds reflect an emphasis on prevention. At the same time, the guidelines cast a wider net for population health management. Socioeconomic status and psychosocial stress are identified as risk factors for high blood pressure that should be considered in a patient's plan of care. The guidelines also recommend that adults with hypertension be screened for smoking, diabetes, dyslipidemia, excessive weight, low fitness, unhealthy diet and sleep apnea. Learn more about the 10 points to remember.