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New blood pressure guidelines include millions more Americans

High blood pressure is now defined as a reading of 130 over 80, down from 140 over 90, increasing the number of Americans who have high blood pressure.

Millions of Americans went to bed one night a few weeks ago and woke up the next day with an unwelcome surprise — suddenly they officially had high blood pressure.

New guidelines issued by the nation’s leading heart experts on Nov. 13 redefined high blood pressure as a reading of 130 over 80, down from 140 over 90, increasing the number of Americans who met the diagnostic criteria for high blood pressure from 72 million to 103 million.

Stanford’s Randall Stafford, MD, PhD, was one of the 21 physicians and researchers who worked for three years to establish the new guidelines. I spoke with him about these new guidelines, which also include treating hypertension more aggressively especially in the elderly, and what they might mean for the newly diagnosed for a recent Stanford Medicine story. He also wrote a series of posts about high blood pressure for Scope.

Stafford, who has struggled with high blood pressure himself since his 20s, discussed why it’s so important to control hypertension. As he said in my story:

The impact of blood pressure is strongest at very high levels of blood pressure (greater than 180 over 110) but is still significant at any level above 120 over 80. For someone in their 50s, a blood pressure of 160 over 100 increases the risk of having a heart attack or stroke by 50 percent compared with a blood pressure of 120 over 80.

The changes to the guidelines were motivated largely by data from a federal study published in 2015 called SPRINT, which showed that lowering blood pressure well below 140 over 90 had substantial benefits, including for older people, Stafford said. He discussed the roadblocks to providing treatment to reduce future risks, which is not the way our current health care system works:

This system is really a 'sick care' system that is organized around dealing with acute, short-term problems rather than issues that need continued attention over time.

Physicians similarly want quick solutions and often don’t have the training needed to provide persuasive advice about lifestyle change. We live in environments that promote obesity and that make healthy choices difficult. Surrounded by advertising promises and hype, consumers themselves want an easy fix to their problems, rather than the hard work required to live a healthier lifestyle. In the end, however, the substantial benefits can make the hard work worth it.

Treating high blood pressure is basically the process of using a combination of medications — such as statins and aspirin— along with lifestyle changes — such as increased physical activity and improved diet — to prevent bad things, like stroke and heart attack, from happening in the future. He suggests that a good first step for many people newly diagnosed with high blood pressure — well, actually for all of us — is to get up off the couch and go for a walk.

Previously: Stanford physician provides insight on use of aspirin to help keep heart attacks and cancer away, Prescribing mhealth: one strategy proves helpful for blood pressure control, The importance of knowing your blood pressure level in preventing hypertension and NIH-funded study shows effectiveness of intensive blood pressure management
Photo by Arek Adeoye

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