Q: My blood pressure runs around 134/82. Based on new hypertension guidelines, do I have high blood pressure?
A: The answer is yes. The new 2017 guidelines released by the American College of Cardiology and the American Heart Association feature three new categories of hypertension:
- High blood pressure: systolic 120-129; diastolic less than 80 mm Hg
- Hypertension Stage 1: systolic 130-139; diastolic 80-89 mm Hg
- Hypertension Stage 2: systolic greater than 140; diastolic greater than 90 mm Hg
These guidelines differ widely from the ones issued in 2014. In 2014, hypertension was defined as greater than 140/90 in patients younger than 60 years of age and greater than 150/90 in patients 60 and older.
Currently, medication is recommended beginning at stage 1.
The drastic changes are the result of a large clinical trial conducted in 2015. Researchers compared the types of treatment used for blood pressure control in more than 9,000 patients, aged 50 and older, with most of the participants aged 60 and older. The outcomes measured were primarily cardiovascular risk of heart attack and death from heart problems.
The study showed that patients who received intensive treatment for systolic blood pressure lower than 120 fared so well that the trial was stopped early.
Although there were some adverse events, such as decreased kidney function, the overall recommendation was to begin intensive treatment at much earlier stages in older adults.
There are two major issues with the new guidelines.
First, the drastic changes in blood pressure levels are based mostly on the one clinical trial in 2015. New recommendations and guidelines are not usually made based on one clinical trial, but only after it has been repeated a few times to ensure consistency.
Second, these new guidelines recommend that millions more people start or take more medication in order to lower their systolic blood pressure (<130). Previously, the recommendation was to begin medication to lower systolic blood pressure <140 or <150, depending on age.
Ultimately, the new guidelines might significantly improve heart health and reduce the number of deaths due to heart attack. But more patients on medication means the likelihood of more side effects.
Providers might try to help patients avoid taking pills by lowering their blood pressure through diet changes and regular exercise.
Talk to your doctor about your best course of treatment.
William E. Kyle, D.O., cares for adult patients at Memorial Health University Physicians-Legacy Center in Okatie.