New Hypertension Guideline Updates How We Measure and Treat High Blood Pressure

John WarnerJohn Warner, M.D., MBA; President, American Heart Association, 2017-18

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 Monday 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.

Here’s what’s new:

  • High blood pressure, previously defined as ≥140/90 mm Hg, is now defined as ≥130/80 mm Hg. This change reflects the latest research that shows health problems can occur at those lower levels. Risk for heart attack, stroke and other consequences begins anywhere above 120 mm Hg (systolic), and risk doubles at 130 mm Hg compared to levels below 120. This lower threshold increases the prevalence of high blood pressure among U.S. adults 20 and older from 32 percent to 46 percent.
  • Blood pressure in adults will be categorized as normal, elevated, stage 1 hypertension or stage 2 hypertension. We have moved away from the category “prehypertension.”
  • Determination of eligibility for blood pressure-lowering medication treatment is no longer based solely on blood pressure level, but now also considers cardiovascular disease risk level.

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. For people with blood pressure higher than 140/90 mm Hg, medication is recommended regardless of risk level.

The AHA has developed excellent companion materials to help the clinical and public health practice communities and other interested parties understand the guideline.

Details aside, the guideline sends a clear directive: We must more aggressively help people lower their blood pressure to healthier levels. Early intervention can help prevent problems, slow damage that has already started and lower the risk for a cardiac event or stroke.

Intervention must involve multi-sector collaboration — such as connecting clinical and community settings that harness technology platforms, healthcare providers, community organizations and volunteer health mentors to help people manage blood pressure. Our collaborative programs that integrate community and clinical health resources have indeed improved blood pressure control.

The Center for Health Metrics and Evaluation will continue to investigate the impact of these integrated efforts, as well as the impact of clinical and community programs on their own. Using data and evidence, the Center will hone best practices for transforming systems, environments and policies to improve blood pressure management.

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.

Furthermore, cultural competence is critical when working with patients. This means that we understand and interact effectively with people of different backgrounds. Culturally sensitive issues and socioeconomic status affect access to basic living necessities, medication, healthcare providers and the ability to adopt lifestyle changes.

For more than 90 years, the American Heart Association has worked to save and improve lives — resulting in a considerable drop in heart disease and stroke death rates. We can’t afford to lose ground now. We have an arsenal of proven strategies to help prevent and treat hypertension, and potential game-changing technology innovations are on the horizon to aid our quest. Working together, we can have a major impact on the health and lives of millions of Americans.