Understanding the New Blood Pressure Guidelines

What Do New Guidelines Mean for Your Heart Health?

New blood pressure guidelines were recently released by an American College of Cardiology/American Heart Association Task Force. The goal was to update the prior guidelines released in 2003 by the Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 

 “In the past, if you were between 120-139 and 80-90, you were considered as having 'prehypertension.' Now the guidelines separate 120-129/<80 as 'elevated' and 130-139/80-89 as 'stage 1 hypertension.' What was previously stage 1 (>140/>90) is now stage 2,“ explains Jennifer Beach, MD, a primary care physician at Beth Israel Deaconess Medical Center’s Healthcare Associates primary care practice. 

 “This change was brought about to emphasize the importance of recognizing elevated blood pressures earlier in life and treating them to prevent complications,” says Dr. Beach.

For those who now fall into an “elevated” stage, it does not necessarily mean taking medication will become part of your daily routine. 

“Lifestyle change is recommended for patients who fall between 120-139/80-89,” says Dr. Beach. “It can potentially delay or reduce your need for medication. That said, lifestyle changes are often hard to maintain. Realistic goals and expectations are important.” 

The new guidelines suggest medication for stage 1 hypertension (130-139/80-89) only if a patient has already had a heart attack or stroke, or is at high risk of heart attack or stroke based on age, has diabetes, chronic kidney disease or other risk factors. 

Dr. Beach also stresses the importance of an accurate diagnosis of high blood pressure. Some people who arrive at a doctor’s appointment just got out of stressful, heavy traffic or had a caffeinated beverage, both of which can raise your blood pressure. Some prescription and non-prescription medications can also raise your levels. Others experience “white coat” syndrome, feeling anxious in a medical environment that results in an abnormally high blood pressure.

“I recommend that decisions about treating high blood pressure (by lifestyle or by medication) be made only after several readings that are properly taken and have consistently shown elevated levels,” says Dr. Beach. Her recommendations for accurate readings include:

• Check your pressure after sitting quietly for five minutes with your back supported and your feet flat on the ground. 
• Make sure the blood pressure cuff is appropriately sized for your arm and placed over bare skin with the arm supported approximately at heart level. 
• Monitor blood pressure at home or use an ambulatory blood pressure device for 24 hours before confirming a new diagnosis of hypertension.

Most importantly, Dr. Beach recommends that patients be honest with their physicians about their lifestyle, including diet, exercise, alcohol consumption and tobacco smoking habits. And, if blood pressure medication is prescribed, it’s important to take it consistently.

“Medical knowledge is an evolving science,” said Dr. Beach. “These guidelines are based on the opinions of a wide range of experts based on their interpretation of the best current data available.  Like many things in medicine, this may and likely will change again in the future as more studies are done and our understanding of the human condition advances and becomes more sophisticated.”