New Blood Pressure Guidelines Mean More Americans Have High Blood Pressure

Feb 9, 2018

If you struggle to keep your blood pressure under control, you’re not alone. Millions of American adults do. After smoking, high blood pressure (also called hypertension) is the second leading cause of preventable heart disease and stroke.

“There’s a good reason it’s called the silent killer,” says Joby James, MD, a board certified internal medicine physician with the USMD Plano North Clinic. “Often there are no symptoms, so many people don’t even know they have high blood pressure or are at risk for developing it.”

Over the years, there has been an alarming uptick in high blood pressure all over the world—due mainly to poor diet, not enough physical activity, excessive alcohol consumption, and other lifestyle factors.

“Because blood is pumped through every organ of the body, every organ feels high blood pressure. Left untreated or undetected, it can gradually damage your organs,” says Dr. James. “For example, the small arteries in the kidneys are not meant to handle high blood pressure like a larger-diameter artery. They’re fragile and can scar or rupture, causing undetectable bleeding which damages kidneys. Along with kidney disease or kidney failure, high blood pressure contributes to the development and progression of plaque which can lead to heart attack, stroke, and neuropathy in the extremities.”

Rethinking blood pressure guidelines

Concerned about the growing number of people diagnosed with high blood pressure, the American College of Cardiology and American Heart Association have released new guidelines that redefine “normal” and “high” blood pressure levels. For years, hypertension was classified as a blood pressure (BP) reading of 140/90 mm Hg or higher. Now the updated guidelines classify hypertension as systolic BP 130mm Hg or higher—or diastolic BP 80 mm Hg or higher.

“The guidelines were updated to help facilitate earlier interventions for individuals at risk,” Dr. James explains. “By helping patients understand their risks earlier, we can take proactive steps to prevent high blood pressure and better control it in individuals who already have it.”

But the lower threshold for high blood pressure places more U.S. adults (nearly 46 percent) in the hypertension category.

The new normal

So, what’s normal blood pressure, and what’s high? Released in November 2017, the new hypertension guidelines lower the levels in every category:

  • Normal Blood Pressure: Less than 120/80 mm Hg
  • Elevated: Top number (systolic) between 120-129 and bottom number (diastolic) less than 80
  • Stage 1 Hypertension: Systolic between 130-139 or diastolic between 80-89
  • Stage 2 Hypertension: Systolic at least 140 or diastolic at least 90 mm Hg
  • Hypertensive Crisis: Top number over 180 and/or bottom number over 120

Combating high blood pressure together

The new guidelines provide a foundation for patient-doctor dialogue. “Every individual is different, so physicians should use the new guidelines not as a black-and-white absolute, but as a tool,” Dr. James notes. “We have to apply these tools in context to each patient. Most importantly, decisions should be made by the patient and physician together after conversations about blood pressure targets, diet, lifestyle, family history, and any other health issues that come into play.”

Know your number

One of the most important steps to combating high blood pressure is knowing your numbers. In fact, Dr. James emphasizes that it’s important to have several readings taken over a period of time. “When I see a patient in my office, I’m seeing a snap shot,” he says. “Before making a life-changing decision about whether or not they should take medication to control their blood pressure, I want to have an accurate picture. That means we need, at minimum, two different blood pressure readings.”

Dr. James also encourages individuals to monitor their blood pressure at home. To get the best possible reading, he advises:

  • Using an upper extremity cuff rather than a wrist cuff. “Upper arm cuffs measure pressure using a large-bore diameter artery closer to your heart, rather than a small artery in your wrist,” he explains. “The closer the cuff is to the heart, the more accurate the blood pressure reading.”
  • Make sure the cuff is adult-sized and fits properly. If it’s too small, it can provide an inaccurate reading.
  • Don’t flex your arm. Your arm should be relaxed and beside your heart.
  • Take your blood pressure at the same time of day for consistency.
  • Avoid taking your blood pressure when you’re stressed or upset.
  • Bring your blood pressure cuff with you when you go to the doctor. “We can see if your unit is calibrated with ours to ensure you’re getting accurate readings at home,” says Dr. James.

If you don’t want to take your blood pressure at home, go to a grocery store health center or pharmacy for a quick check. “Whether you monitor your blood pressure at home or have someone help you, it’s important that we get good data on a regular basis,” adds Dr. James.

What if you have high blood pressure?

“Once we diagnose a stage or classification of blood pressure, conservative, non-pharmacological therapy is going to be the first step in treatment.

Non-pharmacological therapy includes lifestyle changes such as:

  • Reducing salt intake
  • Being more aware of food choices and choosing fresh over packaged foods with a lot of preservatives
  • Paying attention to portion sizes
  • Incorporating cardiovascular exercise into your daily routine
  • Lowering your body fat
  • Reducing stress and eliminating things that can aggravate hypertension
  • Ongoing monitoring of your blood pressure at home and at your doctor’s office

If non-pharmacological measures fail to lower your blood pressure after several months, prescription medication may be necessary. “If you’ve tried to lose weight and can’t, or you can’t get enough cardiovascular exercise due to physical limitations or another medical condition, then that’s when the risk of not treating with medication outweighs the risks associated with medication,” says Dr. James.

The good news is, with proper attention (whether it is non-pharmacological or medication) positive strides can be made to lower your blood pressure to a desirable level. The most important thing to do is know your numbers and take action.

Dr. James is here to help you every step of the way. If you’d like to schedule a consultation, please call 972.596.1747.

Dr. Joby James, USMD North Plano Clinic