Nearly half of American adults will be diagnosed with high blood pressure under new definitions outlined in the 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults, released Monday at Scientific Sessions by the AHA, the American College of Cardiology and nine other health organizations.
Among the changes in the new guidelines, people with readings of 130/80 mm Hg will now be considered to have high blood pressure, down from 140/90 mm Hg that previously defined the condition.
The change means approximately 46 percent of U.S. adults will now be classified as having high blood pressure, compared to 32 percent under the previous definition. Blood pressure less than 120/80 mm Hg still will be considered normal, but levels above that, up to 129, will be called “elevated.”
“Yes, we will label more people hypertensive and give more medication, but we will save lives and money by not having more strokes, cardiovascular events and kidney failure,” said Kenneth Jamerson, MD, professor of internal medicine and a hypertension specialist at the University of Michigan Hospitals and Health Centers in Ann Arbor.
“If you are going to put money into the healthcare system, it’s to everyone’s advantage if we treat and prevent on this side of it, in early treatment,” added Jamerson, one of 21 experts on the guideline writing committee.
Still, the guidelines — in the works for about three years and based on hundreds of studies and clinical trials — don’t suggest a massive increase in the number of people who will need to take hypertension medication. Of the estimated 14 percent increase in adults who will be classified with high blood pressure under the new guidelines, only about one in five will need medication, according to Paul K. Whelton, MD, MSc, who chaired the guideline writing committee.
Instead, the guidelines emphasize physicians should focus on a whole framework of healthier lifestyle changes for patients.
“We need to send the message that, yes, you are at increased risk and these are the things you should be doing,” said Whelton, clinical professor and the Show Chwan Health System Endowed Chair in Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans. “I’m not saying it’s easy to change our patients’ lifestyles, but that should be first and foremost.”
The recommendations for a heart-healthy diet include reducing salt and incorporating potassium-rich foods, such as bananas, potatoes, avocados and dark leafy vegetables. The guidelines also offer specific suggestions for weight loss, quitting smoking, cutting back on alcohol and increasing physical activity.
Robert M. Carey, MD, vice chair of the guideline writing committee, said he expects some controversy over how the new guidelines treat older adults, such as recommending that people over 65 be treated at the same 130/80 mm Hg goal as younger patients. A guideline early this year from the American College of Physicians and the American Academy of Family Physicians suggested patients older than 60 should be held to a standard below 150/90 mm Hg.
But Carey, a professor of medicine and a dean emeritus at the University of Virginia School of Medicine in Charlottesville, said several intensive studies since 2015 show treating older adults to a lower blood pressure goal is important.
“You have to escalate the treatment slower and monitor the side effects,” he said. “But it’s true there is benefit to treating ambulatory, older subjects.”
According to the guidelines, it can be lifesaving: “BP-lowering therapy is one of the few interventions shown to reduce mortality risk in frail older individuals.”
Under the new classification, men and women age 65 to 74 will see high blood pressure rates increase by 13 percent and 12 percent, respectively.
Here’s how some other groups will be affected by the new measurements:
High blood pressure rates nearly triple among men age 20 to 44 — up to 30 percent from 11 percent. Women in that age group will see their rates almost double, to 19 percent from 10 percent.
Roughly three quarters of men between 55 and 74 could be diagnosed with high blood pressure.
Black and Hispanic men will experience a 17 percent increase in rates. Asian men will see a 16 percent increase.
The new classifications and recommendations are specific in how they determine who is at risk and what they should do about it, Jamerson said.
Physicians should use a risk calculator to determine a patient’s risk of heart disease in the next 10 years, he said. That, combined with the other recommendations, can prompt more thorough doctor-patient conversations to determine whether lifestyle changes alone can help, or if other medicine is needed as well.
“These new guidelines give patients a voice because it gives them an opportunity to ask healthcare providers, ‘What’s my risk?’” Jamerson said. “Consumers should be getting an explanation. Physicians ought to be calculating risk as they think about how to treat.”
Full details are available at professional.heart.org/hypertension.