High Blood Pressure For Half Of U.S. With NEW Guidelines

High Blood Pressure For Half Of U.S. With NEW Guidelines

Are you one of the tens of millions of American adults who are now considered to have high blood pressure based on the new guidelines that came out this week?  The American Heart Association and the American College of Cardiology have lowered the levels at which they are calling people high blood pressure just this week.  I’ve had tons of patients coming in and asking about the new guidelines as what it means for them because now they are considered to have high blood pressure.  This post is designed to go over the diagnosis of high blood pressure and what the new guidelines mean for everyone.


What is Blood Pressure?

Blood pressure is the pressure in your blood vessels.  It is measured as 2 separate numbers in millimeters mercury (mm Hg).  The top number is the systolic blood pressure and is the pressure in your blood vessels when your heart is contracting.  The bottom number is the diastolic blood pressure and is the pressure in your blood vessels when your heart is relaxing between squeezes.  Blood pressure normally goes up with exercise and stress, or when your heart is beating really fast. A lot of times a really high diastolic blood pressure is more scary than a high systolic blood pressure.  But, if either of them is consistently high then it means your heart is having to work harder to pump blood through your body and your organs are exposed to higher pressures, which causes organ damage and leads to heart attacks and strokes.

This is the upper arm BP Cuff my grandparents use.


We previously used this smaller wrist BP cuff, but we found it to be less accurate than the upper arm BP cuff.


High Blood Pressure (Hypertension) at Lower Blood Pressures

The lower blood pressures under the guidelines mean that people will be diagnosed with high blood pressure sooner and in just one day I had a third of my patients who formerly were considered normal suddenly meet criteria for hypertension.

New BP Guidelines 2017

  • High blood pressure diagnoses are expected to triple among men under age 45, and double among women under 45 using the above criteria
  • Stage 1 Hypertension doubles the risk of heart disease complications
  • Almost half (46%) of all US adults will now have high blood pressure


Medication for Stage 1 Hypertension

Medication only for people who:

  • Have had a blood vessel disease event such as a heart attack or stroke
  • Are at high risk of heart attack or stroke because of:
    • Age
    • Diabetes mellitus
    • Chronic kidney disease
    • Calculation of blood vessel disease (atherosclerotic) risk using the same risk calculator used to determine high cholesterol treatment

Calculate your blood vessel (atherosclerotic) disease risk for age 40-79 (ASCVD risk)

Calculator for age 30-39 Framingham Coronary Heart Disease Risk Score

You will need your blood pressure and cholesterol levels to calculate.  If risk is >10% then you should be starting medication to lower you BP, not just lifestyle changes.


Medication for Stage 2 Hypertension

  • Start 2 first-line blood pressure medications that work differently (from 2 different classes)
  • First Line medication classes include thiazide diuretics, CCBs, and ACE inhibitors or ARBs


Lifestyle Modifications

What the heck do they mean by lifestyle modifications?  Especially since almost everyone will be needing to do them now.


Lifestyle Modifications
Adapted from Chobanion et al.
  • Weight Management is the most important
    • The less weight you have the less hard your heart has to work to pump blood to your body
  • DASH Diet click link for more info
    • Emphasizes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts
  • Lower salt intake
    • Salt causes you to retain water and increases your blood volume.  The more extra fluid in the body the harder the heart has to work to pump.
  • Physical Activity = Exercise
    • Exercise helps with weight loss and stress relief
  • Limit Alcohol
    • Goals for alcohol are less than or equal to 2 for men and 1 for women daily
  • Stop Smoking
    • Smoking is toxic to the human body and causes damage to blood vessels


What Does it all Mean?

So bottom line, what does it mean for you?  It means that you are going to be diagnosed with high blood pressure earlier.  It means that most people will need to start lifestyle modifications to reduce blood pressure sooner.  The worst part about the new guidelines is it will mean more Americans being diagnosed with hypertension.  Almost half of all Americans will now be called hypertensive and with that diagnosis it will affect things like insurance coverage.  Long term health insurance and life insurance rates change based on your medical conditions and diagnoses.  The good thing and the intent with the new guidelines is to make people more aware of their risks with high blood pressure.  The guidelines are meant to make more people start lifestyle changes to decrease their blood pressure sooner.


High Blood Pressure Complications


The cynical answer is that it will mean more blood pressure medications being prescribed and more money for drug companies.  I choose to believe that this modification will be positive for inciting change in people sooner.  The people can proactively help prevent heart attack, stroke, chronic kidney disease, and ultimately death.


Important Points for Medical Providers

If you are a medical provider click here for the link to the American College of Cardiology’s main points from the new guidelines because the whole report is very unnecessarily LONG.  The summary uses a lot fewer words to outline everything; including which medications to initiate first based on special populations.

  • Initial first-line medication therapy includes thiazide diuretics, CCBs, and ACE inhibitors or ARBs
  • There’s an APP for that: ACC Guideline Clinical App


Let me know what you think of the new guidelines in the comments below or connect with me on Twitter or Facebook via the connect with me links.




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2 thoughts on “High Blood Pressure For Half Of U.S. With NEW Guidelines

  1. I think its crazy!! 120/80 has been the norm for so many years and now anything above it is considered hypertensive? Bleh. Many have labile blood pressures or what about the white coat syndrome? Hmmm. Just reading this is giving me high blood pressure. Maybe add more criteria to add this diagnosis to a person…maybe if its been consistent on 3 consecutive visits or something…or is that already assumed? Placing someone on high blood pressure meds could help but could also encourage unhealthy habits (blame the pessimist in me).
    I think that goes for any diagnosis that isnt so cut and dry. But what do I know😒

    1. There is definitely a lot of controversy about these new guidelines, especially because the lowered BP goals are based on the 2015 SPRINT trial, which caught negative feedback from experts. The full paper goes into further detail about making the diagnosis. It is based on an average of ≥ 2 readings obtained on ≥ 2 occasions to estimate the BP level. Out-of-office and self-monitoring BP measurements are recommended to confirm the diagnosis of hypertension and for titration of meds. You can screen for white coat hypertension using daytime ambulatory blood pressure monitoring or home blood pressure monitoring prior to making the diagnosis of hypertension. At Tripler, where I work, we can order 24 hour ambulatory BP monitoring. Patients get a machine that takes their BP every 15-20 minutes for 24 hours.

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