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The New Blood Pressure Guidelines: It’s not a Conspiracy!

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Live well

Monday, Dec 11, 2017

The New Blood Pressure Guidelines: It’s not a Conspiracy!

Cardiovascular disease (CVD) is the leading cause of death worldwide. In fact, in the U.S. alone, nearly 1 million annual deaths are attributed to CVD. Among the major CVD risk factors is hypertension, which simply means high resting blood pressure. Hypertension is an important risk factor for heart attack, stroke, heart failure, and kidney disease. Because most people with hypertension have no symptoms, it is nicknamed ‘the silent killer.’ Just to be sure the bases are covered, blood pressure is expressed as two numbers; the top number is the systolic, while the bottom number is the diastolic. As is the case with all other major CVD risk factors, hypertension guidelines have changed over time. For example, in the 1950’s it was thought that an acceptable resting systolic blood pressure was 100 plus the patient’s age. So, for a 70 year-old individual, it was OK way back then to have a systolic blood pressure of 170 mmHg!  However, rather than being an evidence-based guideline, this was really just a wild guess due to lack of hard data. As knowledge accumulated from the Framingham Study and other large CVD research projects, experts eventually settled on a cutoff value of greater than or equal to 140/90 mmHg  for identifying hypertension many years ago.

However, based on the results of countless newer studies and more recent clinical trials, the American Heart Association (AHA), American College of Cardiology (ACC), and several other prestigious groups recently announced new guidelines for redefining high blood pressure. It’s important to note that these organizations have rigorous policies and methods to ensure that guidelines are developed without bias or improper influence. We’ll talk more about that in a bit. So, how do these new guidelines change things? The most important change is that hypertension is now defined as a resting blood pressure greater than or equal to 130/80 mmHg rather than the previous cutoff value of 140/90 mmHg. To help put that into perspective, it means that about 46% of the U.S. adult population has hypertension compared with about 33% using the previous definition. A resting blood pressure of less than 120/80 mmHg is still considered the normal category. A summary of the new blood pressure categories for adults of all ages, along with recommendations for each category is shown below in Table 1. In this table, the term ‘high blood pressure’ is equivalent to the term ‘hypertension.’

Table 1. The Newest Guidelines for Hypertension. Source: American Heart Association’s Journal Hypertension. November, 2017.
 

Resting Blood Pressure Category Recommendations

<120 mmHg systolic and <80 mmHg diastolic

 

Normal blood pressure

Healthy lifestyle choices and yearly checks

120-129 mmHg systolic and <80 mmHg diastolic

Elevated blood pressure

 

 

Healthy lifestyle changes, reassessed in 3-6 months

130-139 mmHg systolic or 80-89 mmHg diastolic

 

High blood pressure/Stage 1

 

10-year heart disease and stroke risk assessment. If <10% risk, lifestyle changes, reassessed in 3-6 months. If higher, lifestyle changes and medication with monthly follow-ups until BP controlled

>140 mmHg systolic or >90 mmHg diastolic

High blood pressure/Stage 2

 

Lifestyle changes and 2 different classes of medicine, with monthly follow-ups until BP is controlled

 

Let’s talk a bit more about Table 1. While it’s up to your doctor to make specific recommendations for you, ‘healthy lifestyle choices’ typically include getting more regular physical activity, losing weight if overweight, quitting tobacco, reducing sodium intake, getting adequate sleep, and consuming more unrefined plant-based foods and fatty fish. The 10-year heart disease and stroke assessment tool is used to identify level of risk for individuals who have not had a previous heart attack or stroke. The result of the risk assessment is given as a percentage. For example, if your risk score is 3%, it means that there is a 3% chance that you will have a heart attack or stroke in the next 10 years. That score represents a low risk value. If you know your most recent blood pressure and cholesterol numbers, go ahead and use the link above after reading this blog. Talk with your primary care doctor about the results the next time you have a check-up.    

Now let’s talk about conspiracy theorists. As soon as the new guidelines were announced, comments from non-medical professionals on the web pretty much all stated that the guidelines were orchestrated by ‘big pharma’ so that more people would be put on medication. This would result in pharmaceutical companies making make tons more money. To this, I will shout ‘whoa Nellie!’ As stated previously, the organizations that wrote the guidelines have rigorous policies and methods to ensure that guidelines are free of bias or improper influence. Additionally, even with these new guidelines, only a small percentage of newly-defined hypertensives will need to go on medication. As Table 1 clearly shows, only those Stage 1 hypertensives with a 10-year risk >10% would need medication. For most newly-defined hypertensives, the lifestyle changes mentioned previously should be sufficient to bring blood pressure down to acceptable levels. Finally, although it is up to the discretion of the doctor, diuretics are typically the first type of medication that is used to control hypertension. Are you ready for the punchline? Diuretics are very inexpensive! So, the notion that countless millions of new people are going to be prescribed very expensive blood pressure medication as a result of the new guidelines is patently false! As I often say, being a conspiracy theorist is pretty much a useless hobby. The facts are that because these new guidelines emphasize lifestyle changes and a lower threshold for detecting hypertension, countless heart attacks, strokes, and cardiovascular deaths will be prevented as a result.    

Reference

Whelton, P.K., et al. 2017 High Blood Pressure Clinical Practice Guideline

 

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2017). Hypertension, 70(6).     https://doi.org/10.1161/HYP.0000000000000065

 

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