New Blood Pressure Guidelines Aimed at Starting Treatment Sooner

Most newly classified people won't need medication
New Blood Pressure Guidelines

New guidelines released this week for treating high blood pressure lower the minimum threshold from 140 over 90 to 130 over 80, a change intended to greatly increase the number of U.S. adults diagnosed with the condition in the hope they will get treatment sooner.

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The guidelines, agreed on by 11 medical groups, including the American Heart Association, are expected to reclassify millions of people as having high blood pressure, also called hypertension. They are the first new blood pressure guidelines in 14 years.

The report’s authors say that most people who are newly classified as having high blood pressure will not need medication. Instead, they say that many of those in the early stages of the condition can address it through lifestyle changes.

Borderline patients affected most

Under the new guidelines, more than 100 million Americans will be categorized as having high blood pressure, says preventive cardiologist Haitham Ahmed, MD, Medical Director of Cardiac Rehabilitation at Cleveland Clinic.

The people who will see the most impact are those whose blood pressure has been on the border between high and normal. However, the good news is that research has shown that intervening at an earlier stage can reduce the risk of heart attack and stroke, he says.

“From several clinical trials and studies involving more than 140,000 patients, we now know that if we get the blood pressure down even lower to less than 130 over 80, or even down to the 120s over 70s, then you can reduce risk of heart attack and stroke and increase their longevity,” Dr. Ahmed says.

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For most people, the first step toward lowering blood pressure involves lifestyle modifications such as reducing sodium intake, losing weight, exercising more, reducing alcohol consumption and following the DASH diet, which is high in potassium and fiber and lower in fat, Dr Ahmed says.

For patients who are elderly, or who already have kidney disease, Dr. Ahmed says it’s good to lower their blood pressure, but it can’t be done overnight. Lowering blood pressure too quickly in patients who have had high blood pressure for many years can put them at an increased risk for kidney injury, hypotension, falls or passing out, he says.

Leading cause of heart disease and heart related deaths

High blood pressure is the leading cause of heart disease and heart-related deaths in the United States and worldwide.

It’s important for everyone to see a doctor regularly to know their personal risk and to develop an individual plan for treatment when necessary, Dr. Ahmed says. He advises:

  • Seeing a doctor to make sure your blood pressure is checked correctly
  • Asking your doctor for a risk assessment
  • Know whether you are low-risk, intermediate-risk, or high-risk, especially if you don’t have cardiovascular disease

“Having that discussion with the doctor is going to help guide the context in which your blood pressure is going to be managed,” Dr. Ahmed says.

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Lowering the threshold for what is considered hypertensive can get more people to take a look at their blood pressure and, hopefully, set them on a path toward lowering it sooner, Dr. Ahmed says.

“We know that if we treat the blood pressure to lower targets, we can prevent heart attacks, we can prevent strokes, and we can help our patients lead nice, long prosperous lives — that’s our goal,” he says.

Complete results of the research and guidelines are available on the Journal of the American College of Cardiology.

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