You could have high blood pressure under new guidelines

By Amit Patel, MD  |  12/5/2017

Recently, I met with a healthy, robust patient who exercises regularly. Two weeks prior to our office visit, this person would not have had high blood pressure, which is the measure of pressure in one's arteries.

But due to newly released guidelines from the American College of Cardiology and the American Heart Association, this patient now met the criteria for hypertension, which is high blood pressure.

The new guidelines lower the thresholds of what is considered high blood pressure, labeling millions of additional individuals at risk of a condition that can silently damage the heart, arteries, kidneys and other organs. Now diagnosed with hypertension, many patients are left wondering if they need medication.

High blood pressure

Prior to the guideline change, high blood pressure was determined by a systolic (top number) and diastolic (bottom number) that exceeded 140 over 90. Under the new guidelines, blood pressure measurements above 130 over 80 are considered high.

Similarly, the threshold for stage 2 hypertension lowered from a reading of 160 over 100 or higher to 140 over 90 or higher. In other words, people who had stage 1 hypertension are now considered to have a more severe condition.

Normal blood pressure

Normal and elevated blood pressure targets did not change. Normal remains defined as less than 120 over 80. Elevated is indicated with a top number in the range of 120 to 129, with a bottom number less than 80.

Medication and risk

Does this mean all of these patients now diagnosed with hypertension under the new guidelines will be prescribed medications for blood pressure control? No, not necessarily.

The recommendation for starting blood pressure medication for those with stage 1 hypertension is based on an individual's risk of having atherosclerotic cardiovascular disease, namely stroke or coronary artery disease.

This risk is estimated based on an individual's age, gender, race, cholesterol levels, tobacco use, among other factors. If one's 10-year risk of having atherosclerotic cardiovascular disease is less than 10 percent, or if they have a history of such disease – including prior heart attack or stroke, diabetes or chronic kidney disease – medication is recommended to help lower the risk of cardiovascular disease.

If an individual's blood pressure is equal to or greater than 140 over 90, medication is recommended to lower blood pressure, just like in the old guidelines.

Reducing health risks

An important thing to remember is that medication alone is never the answer. The guidelines emphasize making lifestyle changes along with the use of medication for blood pressure reduction. Lifestyle changes include weight loss in those who are overweight, reduction in salt intake (sodium), increasing physical activity, only drinking alcohol in moderation and enhancing dietary intake of potassium.

If a person has a blood pressure greater than 130 over 80, but a 10-year risk of cardiovascular disease less than 10 percent, the guidelines recommend the lifestyle changes mentioned above.

Ultimately, the new blood pressure guidelines will result in more individuals being diagnosed with hypertension. However, the use of medication for blood pressure control will be reserved for a subset of these individuals.

All individuals with hypertension under the new guidelines should make efforts to adhere to healthy lifestyle habits to help reduce their blood pressure and overall risk of heart and vascular disease. Patients should engage in regular discussion with their healthcare providers regarding measures that can be taken to reduce their risk of heart attack and stroke.

Read more about high blood pressure in the health library here. Evaluate your heart health with this short quiz here.

Dr. Amit Patel is a cardiologist at the Poughkeepsie office of The Heart Center, a division of Hudson Valley Cardiovascular Practice, P.C. His office can be reached at 845-473-1188 (TTY 1-800-421-1220). For more information, visit