Do You Now Have High Blood Pressure Under the New Guidelines?

By Sweta Chandela, MD, Virtua Cardiologist 

There has been a lot of media coverage regarding the new blood pressure guidelines issued by the American Heart Association (AHA) and the American College of Cardiology (ACC). These new guidelines lower the definition of what it means to have high blood pressure, or hypertension, for people of all ages—a significant change from previous guidelines. 

According the American Heart Association, the change means that now 46 percent of U.S. adults will be identified as having high blood pressure, compared with 32 percent under the previous definition. 

You may be wondering what these new guidelines mean for you. Are you at greater risk than you thought? And if so, what should you do about it? Here’s what you need to know.

How have the blood pressure guidelines changed?

Under previous guidelines, you were diagnosed with high blood pressure if you had a systolic blood pressure reading (top number) of 140 mmHg and a diastolic blood pressure reading (bottom number) of 90 mmHg. For patients age 60 and older, some guidelines relaxed that target to 150/80 unless the patient had a history of heart problems or was at high risk for heart disease. 

Under the newest AHA/ACC guidelines, a patient with a blood pressure reading of 130/80 or higher is considered to have high blood pressure, and those guidelines don’t change as you age. Each patient, regardless of age, now is classified into the following categories based on his or her blood pressure reading: 

Normal: Blood pressure of less than 120/80

Elevated: Blood pressure of 120/80 to 129/80

Stage 1: Blood pressure of 130/80 to 139/89

Stage 2: Blood pressure of more than 140/90 

Why have blood pressure guidelines changed?

Because high blood pressure is a major risk factor for stroke and heart disease, the AHA/ACC said that these guideline changes are intended to prevent serious health problems by encouraging doctors and patients to take steps to treat high blood pressure sooner. In some cases, patients can decrease elevated or mildly high blood pressure with lifestyle changes alone—without medication. 

What do the new blood pressure guidelines mean for older people?

The new guidelines mean that older people will now have the same blood pressure target as all other adults. As a result, doctors may begin treating high blood pressure sooner and more aggressively than they would have under the previous guidelines. 

How is high blood pressure treated under the new guidelines?

Treatment for high blood pressure will be based on the category that your blood pressure readings fall into, as well as your individual risk factors. If your blood pressure is in the elevated or Stage 1 range and you have no additional risk factors for heart disease, your doctor may suggest making lifestyle changes to reduce your blood pressure, including: 

Eating a low-sodium, potassium-rich diet. Reducing your daily sodium intake to less than 1,500 mg and consuming between 3,500 and 5,000 mg of potassium per day can reduce your total blood pressure numbers by around 15 mmHg. 

Your doctor may recommend consulting with a registered dietitian to learn how to improve your diet. This would include tips on reducing sodium, adding more potassium, and learning what foods to avoid. And, your doctor or dietitian may specifically recommend a plant-based diet or the DASH (Dietary Approaches to Stop Hypertension) diet, which is effective at lowering high blood pressure.

Achieving or maintaining a healthy weight. Maintaining a healthy weight is very effective for keeping your blood pressure within the normal range. For every kilogram of weight you lose (which equals about 2.20 pounds), your blood pressure decreases by about 1 mmHg.

Exercising. Incorporating more physical activity into your day can reduce your blood pressure and help you achieve or maintain a healthy weight. In fact, exercise alone can lower blood pressure by about 5 mmHg. 

Cutting back on alcoholic drinks. Limiting your alcohol intake to 2 drinks a day for men and 1 drink a day for women can lower blood pressure by about 4 mmHg. 

If your blood pressure falls in the Stage 2 range—or if your blood pressure is in the Stage 1 range and you have other risk factors for heart disease, such as diabetes or high cholesterol—your doctor will prescribe blood pressure medication in addition to recommending lifestyle changes. 

Lifestyle changes alone can result in at least an 18-20 mmHg reduction in blood pressure (not including weight loss, which can result in an even greater reduction). Medication can help lower your blood pressure even more. 

How often should I check my blood pressure?

Checking your blood pressure regularly can help you and your doctor spot potential problems. 

If your blood pressure is normal, you should see your primary care provider annually for a blood pressure check. If you have a mildly high blood pressure reading, your doctor should check your blood pressure again in a month. 

If you’re receiving treatment for high blood pressure or have an elevated reading, you should consider checking your blood pressure at home using a home blood pressure monitor. If you use a home blood pressure monitor, it’s a good idea to bring the device to your doctor’s office so he or she can check to make sure it’s giving accurate readings. 

If you have high blood pressure or are at risk of developing heart disease, call 1-888-VIRTUA-3 for an appointment with a Virtua cardiologist.

Updated October 9, 2018