You’ll Want to Read This: Changes to High Blood Pressure Guidelines


You may have elevated blood pressure or even hypertension under new guidelines. Dr. Michael J. Bloch explains the new numbers and how to stay healthy.

By Michael J. Bloch, MD, medical director, Vascular Care, Renown Institute for Heart and Vascular Health

This past November the American College of Cardiology and the American Heart Association issued updated, comprehensive high blood pressure guidelines for the first time since 2003. Why the changes? In the past decade, researchers have continued to learn more about the relationship between high blood pressure, or hypertension and the risk of cardiovascular disease.

Most important? The guidelines lower the definition of hypertension to blood pressure that is greater than 130/80 mmHg as opposed to the previous cutoff of 140/90 mmHg. The change to this lower threshold for the diagnosis of hypertension is the result of research showing that patients with even mild elevations in blood pressure are at increased risk of cardiovascular complications such as heart disease and stroke. The hope is that adoption of the new guidelines will lead to intervention earlier in the course of high blood pressure elevation and an even greater reduction in cardiovascular risk.

Know the New Numbers

The new guidelines define the following blood pressure categories:

• Normal: Systolic less than 120 and diastolic less than 80 mmHg
• Elevated: Systolic between 120-129 and diastolic less than 80 mmHg
• Stage 1 Hypertension: Systolic between 130-139 or diastolic between 80-89 mmHg
• Stage 2 Hypertension: Systolic at least 140 or diastolic at least 90 mmHg

The new guidelines also emphasize that the diagnosis of hypertension should be based not just on office blood pressure readings, but also on out-of-office measurement, such as at-home monitors or ambulatory blood pressure monitoring. Both in and out of the office, the guidelines highlight the importance of proper patient preparation and technique in measuring blood pressure.


Lifestyle Matters

The new guidelines also call attention to the value of lifestyle modifications, such as diet and exercise, in reducing blood pressure, and the need for risks factors for increased blood pressure, such as psychosocial stressors and socioeconomic status, to be factored in to a patient’s care. Blood pressure lowering medications are indicated in most patients with stage 2 hypertension and in patients with stage 1 hypertension who fall into certain high-risk groups. In fact, many patients with stage 2 hypertension may require two or more medications, often given together in single pill fixed-dose combinations, to keep their blood pressure in check.

The new, lower threshold for the definition of hypertension means an increase in the number of individuals diagnosed with this condition. Based on the new guidelines, approximately 46 percent of adults in the U.S. have hypertension — an increase of 14 percent or 30 million people as compared to previous guidelines. Younger populations will be affected the most; for people under 45 years of age the rate of hypertension will triple among men and double among women. But, since lower risk patients with mild hypertension can be treated with lifestyle changes alone, the updates show only a small increase in the number of patients requiring medication for treatment of hypertension.

Regular Checks are Key

Remember that high blood pressure is known as the “silent killer” — there are usually no symptoms until a heart attack or stroke occurs. As such, it’s important that all adults have their blood pressure checked regularly. As the guidelines emphasize, anyone found to have even mildly elevated blood pressure should make lifestyle changes to help keep their numbers within a healthy range and decrease the risk of cardiovascular complications. These changes include decreasing salt intake, adhering to a Mediterranean-style diet, increasing exercise, maintaining a healthy weight and avoiding excess alcohol.

It’s hoped that these guideline changes will increase awareness about hypertension, prompt lifestyle changes at an earlier stage and target medications to those at higher risk. To learn more about high blood pressure and cardiovascular health, visit the Heart Health page at

This article also appeared in the Reno Gazette-Journal’s Health Source Jan. 28.