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Nearly half of Americans now have high blood pressure, based on new guidelines
November 19, 2017
(CNN)Tens
of millions more Americans now have high blood pressure. Almost half of all
Americans -- 46% -- are now considered to be in the high blood pressure
category based on new guidelines released Monday.
High
blood pressure should be treated at 130/80 rather than 140/90, according to the
new parameters set forth by the American Heart Association, the American
College of Cardiology and nine other health professional organizations.
Practicing
physicians and the public are "going to be a little bit shocked or taken
aback by a diagnosis of Stage 1 hypertension with a blood pressure of 130/80,
which historically has been considered a normal, well-controlled blood
pressure," said Dr. William White, a professor in the cardiology center at
the University of Connecticut School of Medicine.
"That
will involve 50% of men and 38% of all adult women in the US," estimated
White, who was not involved in writing the guidelines. "So it's a huge
number of people."
One
in three Americans had previously been diagnosed with the condition, but now
14% more Americans will be diagnosed with high blood pressure. The new
guidelines will classify 103.3 million people as having high blood pressure,
while the previous guidelines placed only 72.2 million Americans in this
category, according to the authors of the report.
Hypertension
or high blood pressure is second only to smoking for causing preventable heart
disease and stroke deaths, the authors said.
What are the guidelines?
The American College of
Cardiology and the American Heart Association certainly grabbed the attention
of us busy primary care physicians with the recent release of their updated
blood pressure guidelines.
The new guidelines – the first
comprehensive set since 2003 – lower the definition of high blood pressure to
account for complications that can occur at lower numbers and to allow for
earlier intervention. The new definition will result in nearly half of the U.S.
adult population (46 percent) having high blood pressure, with the greatest
impact expected among younger people. Additionally, the prevalence of high
blood pressure is expected to triple among men under age 45, and double among
women under 45, the guideline authors note. However, only a small increase is
expected in the number of adults requiring antihypertensive medication.
Blood pressure categories in the
new guideline are:
- Normal: Less than 120/80 mm Hg;
- Elevated: Systolic between 120-129 and diastolic less than 80;
- Stage 1: Systolic between 130-139 or diastolic between 80-89;
- Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
- Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.
The guidelines eliminate the
category of prehypertension, categorizing patients as having either Elevated
(120-129 and less than 80) or Stage I hypertension (130-139 or 80-89).
While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines. In addition, the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal "white-coat hypertension."
Other changes include:
While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines. In addition, the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal "white-coat hypertension."
Other changes include:
- Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
- Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
- Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient's plan of care.
The authors, who include a panel
of 21 scientists who reviewed more than 900 studies, believe the impact of
their new guidelines will be greatest among younger and middle-age adults, with
prevalence of high blood pressure expected to triple among men under 45 and
double among women under 45.
Drugs will now be recommended for
patients with related health problems coupled with high blood pressure, as
defined by the new guidelines. Worldwide, as well as in the US,
high blood pressure is "sorely undertreated," Frieden said.
"This is unacceptable, and we're committed to seeing this change."
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