The US lower their target blood pressure

29 January 2018

Health experts in the US have lowered the guideline level for diagnosing and treating high blood pressure from 140/90mmHg to 130/80mmHg. This puts nearly half of Americans (46%) in the high blood pressure category.

The new guidelines were developed by the American College of Cardiology and the American Heart Association and published in the journals Hypertension and the Journal of the American College of Cardiology in November. The change is to account for the higher risk of heart attacks and other complications even at these lower levels, and to allow for intervention.   

Since 1997, blood pressure between 120/80mmHg and 139/89mmHg has been considered high-normal, and a reading over 140/90mmHg was considered high, or stage 1 hypertension, as in the UK. Now, a systolic reading (the top number) between 120 and 129mmHg is considered elevated blood pressure, and blood pressure over 130/80mmHg is high, or stage 1 hypertension. Blood pressure over 140/90mmHg is now considered stage 2 hypertension.

While millions more will fall into the high blood pressure category, the authors stress that there won’t be a huge increase in the numbers of people needing medication. Instead, they highlight the urgent need for lifestyle changes in a country facing a growing obesity crisis. Being overweight and having high blood pressure are closely linked, and along with a lack of activity and an unhealthy lifestyle, can lead to diabetes, heart disease, stroke and numerous other health problems.

The guidelines make a number of other recommendations.

• They stress the value of home monitoring in getting accurate blood pressure measurements and avoiding white coat syndrome.
• They only advise using medications for stage 1 hypertension in patients who are at a high risk of heart disease or stroke, namely, if they have had a stroke or heart attack before or have other health problems that make them more likely.
• They recognize that many people need more than one medication, and combining medications into one pill makes sticking to the treatment easier.
• They recognize that psychological stress and socioeconomic factors affect a person’s risk of high blood pressure and should be considered in their care.

 

How do the new US guidelines compare to the UK guidelines?

In the UK, the National Institute for Health and Care Excellence (NICE) recommend 140/90mmHg as the cut off point for diagnosing high blood pressure. Once a diagnosis has been made, GPs will often set a target level to bring each patient’s blood pressure down to. For example, around 140/90mmHg or 130/85mmHg, depending on the individual patient and any other health problems they may have.

If you have blood pressure between 120/80mmHg and 140/90mmHg, this is not considered high blood pressure, but could mean you’re more likely to develop it with time.

If the new US guidelines were applied in the UK, 7 million more adults would be diagnosed with high blood pressure. This doesn’t call for a dramatic change in treatment, but for a renewed focus on healthy living more broadly.

 

Professor Graham MacGregor, Chairman of Blood Pressure UK, explains:

“There is no clear cut off point at which ‘high’ blood pressure is defined, as the risk associated with elevated blood pressure begins at a perhaps surprisingly low reading of 115/70mmHg. But stage 1 hypertension is defined by the NHS as over 140/90mmHg. The new guidelines in the States are extra precautionary, and ours may also change in the future in order to have the maximum benefit on population health.”

 

What to do if your blood pressure is over 120/80mmHg

Nirmala Markandu, Hypertension Specialist Nurse at Blood Pressure UK, gives the following advice to keep your blood pressure healthy.

 
If you have stage 1 hypertension (140/90-160/100) or pre-hypertension (between 120/80 and 140/90) and don’t have any other significant risk factors for heart disease and stroke, such as being overweight or having atrial fibrillation or diabetes, lifestyle modifications can be extremely effective.

 

To cut your numbers:

• Slash your salt intake – processed meat, sliced bread, cheese, soy sauce and condiments are all hidden sources of salt 
• Eat lots of fruit and vegetables – this will raise your potassium levels which lowers blood pressure
• Exercise – start small and build up, even a ten-minute brisk walk per day will help
• Drink alcohol within the recommended limits of 14 units per week – switch to a lower strength beer or a smaller glass of wine start cutting back without having to cut it out
• Lose excess weight – have a look at what you eat each day and see where you can cut out snacks or make simple swaps.

It’s possible to take 15mmHg off your systolic pressure (the top number) through following these measures. This could possibly be enough to stop you needing medication, providing you maintain those changes. Every reduction of 10mmHg reduces your risk of major cardiovascular events, such as a heart attack or stroke, by 20%.

If you already have stage 2 hypertension (over 160/100mmHg), or you have other risk factors such as being overweight or having diabetes, you’ll be offered medication. Medications are usually very effective in getting your blood pressure under control, especially if you make changes to your lifestyle as well.

Read more

Read more about the changes you can make to your lifestyle to lower your blood pressure. Cutting down on alcohol and calories, and building activity into your day, can be easier than you think.

Read more about the guidelines from the American Heart Association. 

Read the guidelines in full in the Journal of the American College of Cardiology and Hypertension.