Managing Heart Risk

Making Sense of the New Blood Pressure Guidelines

Share This

By Deirdre Mattina, M.D.

New guidelines lowering the definition of high blood pressure are designed to change focus from the treatment of heart disease to preventing it in the first place.

In November, the American Heart Association and the American College of Cardiology released new guidelines that lowered the threshold of high blood pressure, also known as hypertension, from 140/90 to 130/80.

The change means approximately 46 percent of Americans will now be identified as having elevated blood pressure, compared to 32 percent under the previous threshold, and will help prevent strokes and heart issues – and potentially save lives.

This is a new strategy in primary prevention because we know that hypertension is the underlying cause of heart disease and strokes in most people. And cardiovascular disease remains the number one killer of most Americans.

This is the first change in blood pressure guidelines in 14 years, according to the American Heart Association. Researchers and doctors established the new guidelines after three years of reviews, based on hundreds of studies and clinical trials. Association leaders said the change reflects the latest research that shows the risk for heart attack, stroke and other consequences begins anywhere above 120 mm Hg (systolic). That risk doubles at 130 mm Hg, compared to levels below 120.

The potential for developing hypertension increases as people age. Some ethnic groups also carry a higher risk. A study cited by the new guidelines showed that 6.5 percent of white, male medical students had developed hypertension by 45 years old, and 37 percent had hypertension by age 65.  Additionally, a multi-ethnic study showed that the 40-year risk for developing hypertension for a 45-year-old was 93 percent for black adults, 92 percent for Hispanic adults, 86 percent for white adults, and 84 percent for Chinese adults.

You Have High Blood Pressure … Now What?

Second only to smoking for preventable causes of death, hypertension happens when blood vessels become stiff leading to pressure build up against vessel walls. This pressure causes the heart to work harder and, over time, the heart muscles weaken, causing heart failure.

Causes of hypertension include smoking, stress, obesity, lack of physical exercise and excessive sodium intake. The good news is the condition can be reversed by addressing the causes and/or by taking prescribed medication.

That said, the change in these guidelines doesn’t necessarily mean that all patients now classified with high blood pressure will need to take medication. Instead of basing the decision solely on blood pressure level as in the past, doctors will also look at other risk factors for cardiovascular disease. Many medical professionals will rely on cardiovascular disease risk calculators, which look at a combination of blood pressure, cholesterol level and medical history.

In fact, the new guidelines place more emphasis on the importance of healthy lifestyle changes to improve blood pressure. I think this is great news for patients because it allows physicians to address cardiovascular risk earlier in life. We can tackle some of those things like smoking cessation, uncontrolled high blood pressure, being overweight, inactivity and poor diet choices sooner rather than later in life.

The new guidelines include specific recommendations about lifestyle changes, including:

  • Healthy diet: Maintain a diet rich in fruits, vegetables, whole grains and low-fat dairy products with reduced saturated and total fat, like the “Dietary Approaches to Stop Hypertension” (DASH) diet.
  • Weight loss: Focus on losing excess weight and body fat. Aiming for your ideal body weight is the best goal, but losing a relatively small amount weight (5-10 pounds) can make a difference in the blood pressure levels of most overweight adults. Expect to lower blood pressure about 1 mm Hg for every 1 kg (about 2.2 pounds) reduction in body weight.
  • Sodium: Reduce intake of dietary sodium. Less than 1,500 mg per day is the optimal goal, but aim for at least a 1,000 mg/day reduction.
  • Potassium: Increase intake of dietary potassium. Doctors recommend 3,500-5,000 mg/day, preferably by consumption of a diet rich in potassium, like bananas, white beans, coconut water, sweet potato, spinach or avocado.
  • Physical activity: Combine aerobic exercise and resistance training. The basic recommendation is 90 to 150 minutes a week of aerobic exercise, like jogging, walking or swimming, which raise your heart rate and “exercise” your cardiovascular system. The guidelines also recommend a combination of strength and resistance training for 90 to 150 minutes a week, to both build strength and muscle.
  • Alcohol: Reduce consumption of alcohol. The recommended daily consumption is no more than 2 drinks for men and 1 drink for women.

Finally, the new guidelines move away from categorizing some people as having “pre-hypertension.” Instead, blood pressure is categorized as “normal” from 120/80; “elevated” with systolic between 120-129 and diastolic less than 80; and “stage 1 hypertension” with systolic between 130-139 and diastolic between 80-89.

This may sound ominous to those who now sit on the precipice of high blood pressure. Look at it as your wake-up call, an opportunity to improve your lifestyle now so you can live a longer, healthier life.

To learn more about your heart risk and blood pressure levels, make an appointment with your doctor. To make an appointment with a Henry Ford doctor, visit henryford.com or call 1-800-HENRYFORD (436-7936).

Written By:

Deirdre Mattina, M.D.

Deirdre Mattina, M.D., is a Senior Staff Cardiologist at Henry Ford Hospital and Director of the Women’s Heart Center. She began her medical training at the University of Michigan Medical School and went on to complete her Internal Medicine Residency at Columbia University in New York City and, finally, her Cardiology Fellowship at Henry Ford Hospital. Dr. Mattina is board certified in Internal Medicine, General Cardiology, Echocardiography and Nuclear Cardiology. While she cares for patients with all types of cardiac conditions and risk factors, she has a special interest in preventive cardiology, women’s health and healthcare disparities.

16 articles