Lowered blood pressure guidelines mean hypertension for nearly half of U.S.
A systolic reading of 130 is the new 140 – and both indicate high blood pressure.
At the scientific sessions of the American Heart Association last week, AHA and the American College of Cardiology released updated definitions and guidelines – the first update in 14 years – for what constitutes hypertension. If the top number, systolic blood pressure, reads from 130 to 139 mm Hg or the bottom number, diastolic blood pressure, reads from 80-89 mmHg, it is considered stage 1 hypertension. Previously, it was 140/90.
If you had what was considered prehypertension last week, then you have high blood pressure this week. Prehypertension (formerly a systolic number between 120-139 mmHg or a diastolic number between 80-89 mmHg) is eliminated from the new guideline categories. Those readings are now categorized as either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). Readings of 140/90 mm Hg are now classified as Stage 2 hypertension.
Previously, about one-third of Americans were estimated to have hypertension. Under the new guidelines, nearly half of the U.S. has high blood pressure. The impact is expected to be greatest among younger people, the AHA said. The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under age 45, according to the report.
Jin-Moo Lee, M.D., president of the Board of Directors for the St. Louis Chapter of the AHA and head of the Stroke Center at Washington University and Barnes Jewish Hospital, said evidence prompted the change.
“The reason for this adjustment was there was a very extensive review of the evidence in the literature, and all of the accumulative evidence suggests that at the lower blood pressure there is still risk for the consequences of high blood pressure,” Dr. Lee said. “Even at that lower 130/80, there is still that risk of heart disease and consequences of chronic hypertension.”
The AHA says 59 percent of African-American men and 56 percent of African-American women have high blood pressure.
“Earlier intervention is important for African Americans,” said Kenneth A. Jamerson, M.D., a guideline author, cardiologist and professor of cardiovascular medicine with the University of Michigan Health System at www.heart.org.
“Hypertension occurs at a younger age for African Americans than for whites. By the time the 140/90 is achieved, their prolonged exposure to elevated blood pressure has a potential for worse outcome.”
AHA reports that heart disease also develops earlier in African Americans and high blood pressure plays a role in more than 50 percent of all deaths from heart disease. African Americans have a higher rate of heart attacks, sudden cardiac arrest, heart failure and strokes than do white Americans. In addition, the African-American risk for end-stage renal disease is 4.2 times greater than whites, which often requires regular dialysis to filter the blood to maintain survival and the need for kidney transplants.
The new, lower and more aggressive blood pressure guidelines are not such a bad thing, Dr. Lee said, because it allows interventions to start sooner. While conversations must take place between doctors and patients with high blood pressure to bring readings in line and cardiovascular disease risk under control, the earliest solutions are not necessarily in a pill bottle.
“When people are defined as being hypertensive, not all of them will be required to take medications. The suggestion is that only those who are at high risk for heart disease should take medicines,” Dr. Lee said.
The guidelines recommend medication for Stage I hypertension only if a patient has already had a cardiovascular event such as a heart attack or stroke, or if the patient is at high risk of heart attack or stroke based on age, the presence of diabetes, chronic kidney disease or risk of plaque in the arteries.
Dr. Lee said for persons who are at the borderline of high blood pressure can make lifestyle changes to lower their risk.
“Some of these lifestyle interventions include physical activity – aerobic exercise as well as other types of exercise, healthy diet, weight loss, reduced sodium intake, moderate alcohol intake and enhanced intake of dietary potassium,” he said.
Lifestyle changes can help persons currently taking blood pressure medicine reduce or eventually eliminate the need for medicine in the long run.
“Medicine alone won’t do the trick,” Dr. Lee said. “You really need every trick up your sleeve, so that includes the lifestyle changes as well as medication if you are at a higher level of high blood pressure.’
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