Millions of Americans will need to undergo lifestyle changes to treat hypertension. Experts released a new set of guidelines for the diagnosis and treatment of high blood pressure.
The new guidelines formulated by the American Heart Association and the American College of Cardiology stated that patients with or at risk of developing a cardiovascular disease (CVD) should have a blood pressure reading lower than 130/80 mmHg (millimeter of mercury) to improve their quality of life.
This means that more Americans will have a diagnosis of hypertension on their next hospital visit, and previously diagnosed hypertensives may need to work harder to bring their blood pressure down to acceptable levels. Based on the new guidelines, there will be about 103 million American adults with high blood pressure, up by 32 percent under the previous guidelines.
Understanding The New Guidelines
A person has hypertension if there is presence of elevated blood pressure on three separate occasions. High blood pressure occurs when the blood that flows through the body remains high.
In the United States, about half of adults are unaware of their blood pressure readings, with many of them not knowing they are already hypertensive.
The practice guidelines released (PDF) stated that those with a CVD risk of at least 10 percent should work on having a blood pressure level below 130/80 mmHg. Based on a previous study, individuals aged 65 years old and older have a 60 percent of relative risk of developing CVD.
Aside from focusing on individuals with advanced age, the guidelines also touched on young patients with several preexisting medical conditions such as kidney disease, heart failures, or diabetes.
Below are the new guidelines:
Blood Pressure Category | Systolic (mmHg) | Diastolic (mmHg) | |
NORMAL | LESS THAN 120 | and | LESS THAN 80 |
ELEVATED | 120-129 | and | LESS THAN 80 |
STAGE 1 HYPERTENSION | 130-139 | or | 80-89 |
STAGE 2 HYPERTENSION | 140 OR HIGHER | or | 90 OR HIGHER |
HYPERTENSIVE CRISIS | HIGHER THAN 180 | and/or | HIGHER THAN 120 |
Patients with no known risk factors should maintain a blood pressure between 130/80 and 140/90 and should undergo lifestyle and dietary modifications, while those with risk factors such as previous heart diseases or diabetes will be given medications and advised lifestyle changes.
Patients with a blood pressure reading of 140/90 will have two different anti-hypertensive medications and lifestyle changes. Those with existing medications may need to have higher doses or additional drugs to manage their blood pressure.
Medical experts reviewed more than 1,000 studies, but most of the formulations were from the study made in 2015. The Sprint trial showed individuals with lowered blood pressure have a lower risk heart failure and death.
Applying The New Guidelines
With the guidelines in place, more doctors are urging their colleagues to be aggressive in diagnosing and treating their patients. Patients should also become aware of their risks.
"We want to be straight with people — if you already have a doubling of risk, you need to know about it," said Paul Whelton, professor of global public health at Tulane University School of Public Health and Tropical Medicine. "It doesn't mean you need medication, but it's a yellow light that you need to be lowering your blood pressure."
Treating high blood pressure in accordance with the new guidelines should not replace clinical judgment. Dr. Raymond Townsend, director of the hypertension program of Penn Medicine and professor of medicine at University of Pennsylvania, noted that patients in the Sprint trial with lowered blood pressure have increased acute kidney injury.
"Although the lower goal was better for the heart, it wasn't better for the kidney," said Townsend, who is also a kidney specialist.
Many cardiologists second Townsend's concern — noting that current treatment strategies are not effective in many hypertensive patients. Dr. Harlan Krumholz, a cardiologist from Yale University, said that problems may arise from patients who resort to medications to lower blood pressure instead of adhering to lifestyle modifications. He added that managing hypertension should be a collaboration between doctors and patients.
"How they tolerate drugs, whether they want to pursue lower levels, are all choices and should not be dictated to them," said Krumholz. "Or we will have the same situation as today — many prescriptions that go unfilled and pills untaken."
