Image: New guidelines now classify many more people as suffering from hypertension (Photo courtesy of the American Heart Association).
A new guideline by the American Heart Association (AHA; Dallas, TX, USA) defines high blood pressure as a reading of 130/80, meaning that 46% of adults in the United States are now identified as having high blood pressure.
Under the new guideline, the number of adults with hypertension will rise from 72 million under the previous standard to 103 million. The number of men under age 45 with a diagnosis of hypertension will triple, and the prevalence among women under age 45 will double. The new diagnostic revision, the first since 2003, resulted from growing evidence that blood pressure lower than that previously considered normal greatly reduces the chances of heart attack and stroke, as well as overall risk of death.
According to the new guideline, anyone with at least a 10% risk of a heart attack or stroke in the next decade should aim for blood pressure below 130/80. This includes people with conditions such as heart disease, kidney disease, or diabetes, and just being over 65 years of age. But of the additional 14% of adults due to be classified with high blood pressure, only one in five will need medication, compared with the previous AHA 2003 guideline recommendation. Instead, the guideline emphasizes that doctors need to focus on a whole framework of healthier lifestyle changes for patients.
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 guideline also gives specific suggestions for weight loss, quitting cigarettes, cutting back on alcohol, and increasing physical activity. In addition, the AHA recommends that the atherosclerotic cardiovascular disease (ASCVD) algorithm, which is available online (www.cvriskcalculator.com), be used to calculate 10-year risk of heart disease or stroke, as the assessment may prompt more thorough doctor-patient interaction. The new guideline was published on November 13, 2017, in Hypertension.
“Yes, we will label more people hypertensive and give more medication, but we will save lives and money by preventing more strokes, cardiovascular events, and kidney failure,” said Professor Kenneth Jamerson, MD, PhD, of the University of Michigan Health System, one of 21 experts on the guideline writing committee. “Physicians ought to be calculating risk as they think about how to treat. 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.”
Contrary to the AHA guideline, the 2014 Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) evidence-based guideline increased the systolic treatment goal from less than 140/90 mm Hg to less than 150/90 mm Hg, although committee members did not recommend it unanimously. JNC-8 also changed targets for adults with chronic kidney disease (CKD) and diabetes from less than 130/80 mm Hg to the less than the 140/90 mm Hg target goal recommended for the general population.
American Heart Association