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New Blood Pressure Guidelines

As you may be aware, the blood pressure guidelines were recently updated by the American Heart Association (AHA) and the American College of Cardiology (ACC) in November of 2017. Importantly, under the new blood pressure guidelines, approximately 45.6% of Americans over the age of 18 are now considered to have hypertension (1). That is over 103 million American adults!

With the introduction of these new guidelines, the prevalence of hypertension in the U.S. has increased by nearly 15%, meaning that many more Americans are at risk for life-threatening cardiovascular complications such as heart failure and heart attack.

Here, we will briefly review what’s new in these blood pressure guidelines, why they were changed, and a few health tips to help improve your blood pressure and heart health.

Chart summarizing the new 2017 blood pressure categories


Credit: copyright American Heart Association

The Overnight Hypertensive

You may have already noticed one of the most important changes to the guidelines, which is that the cut-offs for stage 1 and stage 2 hypertension have been lowered. Now, with the updated guidelines, an individual may be considered hypertensive with a systolic blood pressure in the range of 130-139 mmHg or a diastolic blood pressure between 80-89 mmHg. Although a subtle change, lowering of the systolic blood pressure range for stage 1 hypertension by only 10 points increased the overall estimated prevalence of hypertension in the U.S. by nearly 15%. This shift has now placed an additional estimated 15 million Americans in the stage 1 hypertension category or greater, practically over night!

New Categories

Importantly, there are also two new categories in the new AHA/ACC 2017 blood pressure guidelines. These categories are “Elevated” blood pressure and “Hypertensive Crisis”. The elevated blood pressure category has replaced what was previously the pre-hypertensive category in order to highlight the complications that heightened blood pressure is associated with. The committee responsible for drafting the new guidelines felt that the pre-hypertensive terminology was not impactful enough, considering that many individuals were at increased risk of cardiovascular complications yet were not considered hypertensive according to the previous guidelines.

Additionally, there is a new hypertensive crisis category which accentuates the urgent risk of extremely high blood pressure. Under any circumstance, if your blood pressure exceeds 180 mmHg systolic or 120 mmHg diastolic, immediately contact your healthcare provider. Resting blood pressures at these levels can permanently damage your heart, lungs, eyes, kidneys, and brain while putting you at significant risk for heart failure, kidney failure, and blindness.

Reasons for Change

In all, the parameters for high blood pressure were lowered by the new guidelines in order to account for complications that can occur at lower numbers and to encourage earlier intervention using non-drug therapies. The new guidelines even recommend that medication is not prescribed for stage 1 hypertension unless the patient already has known cardiovascular disease, diabetes, chronic kidney disease, and/or high calculated risk of heart disease and stroke. If possible, the treatment plan focuses solely on healthy lifestyle recommendations and regular follow-up to monitor progress.

Lifestyle factors that can increase blood pressure:

  • Increased Stress

  • Cigarette smoking

  • Excess alcohol consumption

  • Elevated intakes of salt

  • Physical inactivity

  • High consumption of sugar sweetened beverages

Steps you can take to reduce blood pressure:

  • Exercise regularly

  • Drink more water

  • Manage your stress levels and get enough sleep

  • Reduce total salt consumption to lower than 2,300 mg/day

  • Eat more fruits and vegetables

  • Watch your weight

  • If you drink alcohol, do so in moderation

  • If you smoke, take the necessary steps to quit

In summary, the updates to the new blood pressure guidelines emphasize the importance of maintaining healthy blood pressure. Keep an eye on your blood pressure as it is an important indicator of your overall health and wellness. If you find that your resting blood pressure is too high, or if you’re worried that it might be, contact your doctor and local registered dietitian for help. Stay tuned for more THG blogs and heart healthy nutrition and wellness tips to keep your heart in tip-top shape!

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1. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT, Whelton PK. Potential U.S. Population Impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Circulation. 2017


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