Nearly half of U.S. adults could now be classified with high blood pressure under new guideline definitions


A growing health crisis has a grip on our nation. It’s not a new epidemic or disease — it’s high blood pressure, the “silent killer.”
Many more people than previously believed are at risk for this far too common condition that increases the chance for heart disease and stroke, according to a new guideline for high blood pressure prevention, detection, evaluation and management released recently by the American Heart Association.
“The AHA, the American College of Cardiology and nine other health professional organizations followed a rigorous review and approval process to develop this first update since 2003 to comprehensive U.S. high blood pressure guidelines,” said Dr. Matthew Bosner, Director of Cardiology Services at Ste. Genevieve County Memorial Hospital.
Dr. Bosner explained that there are now four blood pressure categories.
“Blood pressure in adults is now categorized as normal, elevated, stage 1 hypertension or stage 2 hypertension,” he said. “We have moved away from the category ‘prehypertension.’ What was categorized as prehypertension, 130/80, is now considered to be high blood pressure. This change reflects the latest research that confirms health problems can occur at those lower levels. But even with the new threshold for high blood pressure, the percentage of U.S. adults for whom medication is recommended along with lifestyle management will only increase slightly.”
Bosner explained that blood pressure is defined as two numbers. The top number (systolic) is peak blood pressure that is generated after the heart pumps and blood is pumped through the vascular system. The bottom number (diastolic) is the resting ambient blood pressure.
“What we find is that the top number, for those over 50 years of age, is the most important risk for cardiovascular disease in the future, such as a heart attack, stroke or heart failure, and the bottom number generally stays stable over the age of 50,” said Dr. Bosner. “But if the diastolic pressure (lower number) becomes elevated, we have to watch it closely because that is commonly associated with progressive kidney disease.”
High blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking. It’s known as the “silent killer” because often there are no symptoms, despite its role in significantly increasing the risk for heart disease and stroke.
“That’s why it’s critically important to know your numbers,” said Bosner. “Symptoms are very vague with high blood pressure. An individual may feel fine, but they may also feel a little weak, a little tired or have headaches. These are very common symptoms. Providers should check blood pressure every time they come into contact with a patient. For instance, I went to the dentist recently and they checked my blood pressure. I thought that was excellent. Checking your blood pressure and then referring back to your primary care provider as the initial access to the medical system is recommended if someone’s random blood pressure check is greater than 120 for the top number and greater than 80 for the bottom number. on 2-3 repeated measurements.”
The new guidelines stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions, explained Bosner.
Bosner said the guidelines stress the use of home blood pressure monitoring using validated devices and appropriate training of healthcare providers to reveal “white-coat hypertension,” which occurs when pressure is elevated in a medical setting but not in everyday life. Home readings can also identify “masked hypertension,” when pressure is normal in a medical setting but elevated at home, thus necessitating treatment with lifestyle and possibly medications.
Numbers may tell only half the story, though, said Bosner.
“The most important factor is an individual’s overall cardiac risk,” he said. “We call that a risk calculator. Those with a higher risk (10% risk of a cardiovascular event in 10 years), will be treated more aggressively than in the past. The risk calculator can help to determine a patient’s risk of heart disease or stroke over the next 10 years. That assessment, combined with the other recommendations, can prompt more thorough doctor-patient conversations to determine whether lifestyle changes alone can help, or if medication is needed as well.
Details aside, Bosner said the new guideline sends a clear directive.
“We must more aggressively help people lower their blood pressure to healthier levels,” said Bosner. “Early intervention can help prevent problems and slow damage that has already started, and lower the risk for a cardiac event or stroke. Maintaining blood pressure within safe targets is not a one-time event. Such control requires close monitoring and regular communication between patients and healthcare providers.”

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