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Thirty Million Americans Just Got High Blood Pressure

The threshold for having hypertension has been lowered, which means another 14% of the population is in the danger zone.
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New guidelines issued by U.S. medical societies have expanded the definition of hypertension for the first time in 14 years, classifying 30 million more Americans as having high blood pressure.

The change means almost half of the nation’s adults, or 103 million people, are technically classified as having hypertension, up from one-third. But don’t worry too much—if you are one of the newly initiated, the experts aren’t suggesting anything radical. Just take some common sense steps to avoid future cardiovascular complications.

The update by the American College of Cardiology and the American Heart Association is based on a three-year review of almost 1,000 studies. A healthier diet and more exercise, unsurprisingly, are the primary recommendations for those who fall into the new category of stage 1 hypertension, previously called “pre-hypertension” or “high-normal blood pressure,” said Paul Whelton, chair of global public health at the Tulane University School of Public Health and lead author of the guidelines.

“We didn’t like either of those terms because we felt—at that stage—somebody is already at substantial increased risk,” he said at a briefing Monday at the AHA’s annual meeting in Anaheim, California. And for those who had normal blood pressure before the new gauge, Whelton had some good news: “Normal hasn’t changed.”

Of those newly categorized as having high blood pressure, some 4.2 million also have other risk factors for heart disease. These individuals should start taking medicine to lower their numbers, the researchers said. While many patients need multiple drugs to get their blood pressure into a healthy range, most treatments are available as less-expensive generic pills.

Cardiovascular disease is the leading cause of death in the U.S., killing 800,000 Americans and accounting for 670,000 heart attacks annually. Hypertension, where the force of blood pushing against blood vessel walls is elevated, is considered the second-largest cause of preventable heart disease after smoking. Damage to the inside of arteries and other blood vessels can grow over time, and rates of hypertension increase with age.

A blood pressure reading is generally given as a ratio, with normal being 120 millimeters over 80 millimeters of mercury, or mmHg. The top number is known as the systolic rate, measuring the pressure on your blood vessels when the heart beats. The lower number is the diastolic reading, or the pressure level between the contractions when the heart is filling with blood.

With the new guidelines, full-blown hypertension is diagnosed if either the systolic or diastolic reading is above the level given:

  • Normal: Less than 120/80 mm Hg
  • Elevated: 120-129/less than 80 mm Hg
  • Stage 1 Hypertension: 130-139/80-89 mm Hg
  • Stage 2 Hypertension: At least 140/90 mm Hg
  • Hypertensive crisis: Over 180/120 mg Hg

“It’s normal to have a systolic blood pressure of 120 and a diastolic below 80, and that’s what we should all be aiming to have,” Whelton said. “We want to be straight with people—if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

The change is expected to triple the number of men under age 45 diagnosed with hypertension and double the number among women the same age. The vast majority will be told to improve their lifestyles, with a healthier diet, weight loss, exercise and cutting back on alcohol and salt. Only those who have other factors that put them at risk of heart disease should be given medication, said Robert Carey, professor of medicine at the University of Virginia School of Medicine.

“Lifestyle modification is the cornerstone of treatment for hypertension,” Carey said. “We expect this guideline will cause our society and our physician community to really pay attention much more to lifestyle recommendations.”

They also recommend a new approach to accurately measure blood pressure. A person’s level should be the average of several readings, including those done outside of the doctor’s office. “White coat hypertension,” which occurs when a person’s blood pressure spikes while in the doctor’s office, is a known phenomenon that can mar the test’s accuracy.

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