Hypertension | Understanding New Treatment Guidelines

Rosalind Kaplan, MD

Hypertension (high blood pressure) is one of the most common medical problems in adult patients worldwide. In the U.S., hypertension affects about 50% of people 60-69 years old and about 75% of people over 70.  Worldwide, about 40% of people between the ages of 35 and 70 have high blood pressure, but less than half of these people are aware they have it.  Even fewer people truly understand the risks associated with high blood pressure.

As May is Hypertension Education Month, it is an ideal time to review and to shed light on some evolving hypertension treatment guidelines. 

Hypertension was initially defined as a blood pressure level above 140/90.

  • Top number: systolic blood pressure (refers to the amount of pressure in a person’s arteries during contraction of the heart muscle)
  • Bottom number: diastolic blood pressure (the pressure in the arteries between beats)

In 2017, The American College of Cardiologists and the American Heart Association reviewed new data on both the consequences of untreated high blood pressure and the complications of related medical treatment.  As a result, the official definition of hypertension was revised and the updated guidelines suggested a more aggressive treatment plan.  In fact, blood pressures initially defined as ‘normal’ were now considered ‘elevated’, and what was considered ‘borderline’ was now squarely in the ‘hypertensive’ range. 

The following includes the blood pressure categories according to the new guidelines:

  • Normal: Less than 120/80
  • Elevated: Systolic 120-129 AND Diastolic less than 80
  • Stage 1 Hypertension: Systolic 130-139 OR Diastolic 80-89
  • Stage 2 Hypertension: Systolic 140 or higher OR Diastolic 90 or higher

The new guidelines recommended that patients with elevated BP or either stage of hypertension implement several lifestyle changes including:

  • Low-salt diet
  • Progress in reaching and maintaining a healthy weight
  • Regular exercise

Additionally, medication is now recommended for patients with Stage 1 Hypertension if they have already had a heart attack or stroke, or if the patient has diabetes, kidney disease, or is at high risk for heart attack or stroke (based on a calculation that includes cholesterol and several other factors).

Stage 2 Hypertension always requires medication along with the recommended lifestyle changes. These new guidelines tripled the number of men under 45 years-old considered to have hypertension, and doubled the number of women under 45 considered to have hypertension.

Blood Pressure Measurement Insights

Numerous factors can influence the accuracy of a patient’s blood pressure reading. For instance, the patient’s stress level evoked by the doctor’s office setting is considered ‘white coat hypertension’. This can result in an uncharacteristically high BP reading. If blood pressure varies widely from visit to visit, patients may be asked to check their blood pressures with high-quality monitors at home. They will then be instructed to provide their physician with the updated readings for up to three months. If there is still uncertainty about the need for medication, ambulatory blood pressure monitoring is recommended. This requires a heart or kidney specialist’s intervention in utilizing a special device that constantly monitors a patient’s blood pressure throughout their daily activities.

The universal risks for high blood pressure include:

  • Genetics
  • Obesity
  • A sedentary lifestyle
  • High salt intake

Socioeconomic status and psycho-social stress have been recognized as additional risk factors, and doctors need to consider this in determining proper treatment of hypertension.

Untreated hypertension is a significant risk factor for heart disease, stroke, kidney disease, and other vascular diseases. Continual education on evolving research and guidelines will increase mindfulness of high blood pressure and its signs. Early detection of hypertension allows for more effective treatment methods and lifestyle modifications. By understanding your own blood pressure risks and the proper way to monitor blood pressure, you can help your doctor help you. Understanding the hypertension identification and treatment changes over the years can also help you to understand any changes needed in your own care!

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