Definition of High Blood Pressure Is Lowered by 10 Points

Guidelines were changed to prevent more cardiovascular events and deaths.

High blood pressure used to be defined as 140/90 mmHg (millimeters of mercury). That’s the point at which guidelines recommended blood pressure-lowering medications be started.

But when a review of more than 900 clinical trials found that a reading of 130/80 mmHg offered far greater protection against stroke, cardiovascular death and all-cause death, the American Heart Association and American College of Cardiology issued new guidelines lowering their definition of high blood pressure.

“The goal is to reduce the number of serious events caused by heart disease and stroke, and a lower blood pressure appears to protect the vessels over time,” says Cleveland Clinic preventive cardiologist Haitham Ahmed, MD, MPH.

Medication May Not Be Needed

Drawing the line between normal and high blood pressure at 130/80 mmHg means that nearly 50 percent of U.S. adults suddenly have hypertension. This is not expected to cause a large increase in the number of patients needing antihypertension medications, however, since the guidelines emphasize trying non-drug approaches first.

“Reducing alcohol use and sodium intake, adopting the DASH (Dietary Approaches to Stop Hypertension) diet, increasing exercise and losing weight will help blood pressure come down naturally. Medications are recommended only if blood pressure does not drop enough, and the patient has a history of heart attack or stroke or is at high risk for one,” says Dr. Ahmed.

Safety Issue Addressed

While some physicians expressed concern that lowering blood pressure in older patients might cause an increase in falls or kidney damage, Dr. Ahmed says these problems can be avoided by lowering blood pressure slowly. “The SPRINT trial showed us that even in people over age 75, lower blood pressure led to better long-term outcomes,” he says.

Diabetics Exempted

Patients with diabetes may be exempted from stricter blood pressure control, since the benefit of more intensive blood pressure control in those patients is less clear.

“It may be the result of other medications and comorbidities. For example, patients with diabetes frequently have concomitant kidney disease and are commonly on medications such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), which may worsen kidney function if the dose is raised too aggressively. We just need to be a lot more careful in these patients,” says Dr. Ahmed.

“The 2018 American Diabetes Association guidelines recommend these patients maintain a blood pressure less than 140/90 mmHg. We say we can treat to 130/80 mmHg, if the benefits outweigh the risk.”