Wednesday’s Ask Dr. Walt — Hyper about New Hypertension Guidelines

Dear Dr. Walt,

I’m confused about the new high blood pressure guidelines. When in blood pressure abnormal? 130/80 or 140/90?

—Feeling Pressure in Nevada  

Dear Stressed,

You may be referring to some new guidelines that have us doctors debating about when to diagnose hypertension and when to start treatment. Most physicians and patients are used to thinking of a blood pressure (BP) goal of a systolic blood pressure of less than 140 mmHg and a diastolic blood pressure of less than 90 mmHg. In 2013, one group of experts actually relaxed the goal to less than 150/90 for patients age 60 or older without diabetes or kidney disease.

Now the new American College of Cardiology and American Heart Association have guidelines recommending a stricter goal of less than 130/80 across the board.   But other groups, such as the American Academy of Family Physicians and American Diabetes Association, are sticking with a goal of below 140/90 for many patients.

With my patients, I’m combining both sets of guidelines in a way that is recommended by the experts at Prescriber’s Letter:

  • Normal: Systolic less than 120 AND diastolic less than 80. I’m telling these patients begin or maintain healthy lifestyle habits.
  • Elevated: Systolic 120-129 AND diastolic less than 80. For these folks, I recommend lifestyle changes including diet, exercise, smoking cessation, etc. Also, I’ll check for medications that can increase BP, such as NSAIDs, some antidepressants, estrogen, etc.
  • Stage 1 hypertension: Systolic 130-139 OR diastolic 80-89. Here I recommend lifestyle changes alone if cardiovascular risk (CV) is low (ACC/AHA 10-year CV risk less than 10%). But I recommend BP medications for patients with existing CV disease, diabetes, chronic kidney disease, or a 10-year CV risk of 10% or more.
  • Stage 2 hypertension: Systolic 140 or more OR diastolic 90 or more, I reinforce lifestyle changes AND use BP medications.

But, I recommend you discuss your particular care with your personal physician who knows you best and can tailor the optimal treatment plan for you.

Dr. Walt

© Copyright WLL, INC. 2018. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.
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