The new lower threshold for determining high blood pressure is expected to add 30 million Americans to those who have the condition, which now plagues nearly half of U.S. adults. High pressure, which for decades has been a top reading of at least 140 or a bottom one of 90, drops to 130 over 80 in advice announced Monday by a dozen medical groups. A major study two years ago found heart risks were much lower in people who were around 120. Canada and Australia have already lowered their cutoff to that reading. In Europe is still 140, but is due to be revised next year.
What is considered normal in children varies with age, height and gender. After age 13, the levels defining high pressure are the same as for adults. The reason the age of 13 was selected was because it was reasoned that when a person turns 18 they shouldn't suddenly have a new definition of what constitutes high blood pressure. So, the age was lowered and now when a kid turns 13 they suddenly have a new definition of what constitutes high blood pressure.
The change means an additional 14 percent of U.S. adults have the problem, but only 2 percent of these newly added people need medication right away; the rest should try healthier lifestyles, which get much stronger emphasis in the new advice. Poor diets, lack of exercise and other bad habits cause 90 percent of high blood pressure. Currently, only half of Americans with high blood pressure have it under control.
Dr. Paul Whelton of Tulane University was head of the guidelines panel and stated that he expects there will be a controversy. Naturally, the risk for heart disease, stroke and other problems drops as blood pressure improves but the new advice "is more honest" about how many people have a problem, he said.
Normal: Under 120, over 80
Elevated: 120-129, less than 80
Stage 1 Hypertension: 130-139, 80-89
Stage 2 Hypertension: at least 140 or at least 90
The new guidelines mean 46 percent of U.S. adults have high pressure versus 32 percent under the old levels and those having high blood pressure will triple in men under 45, to 30 percent, and double in women under 45 to 19 percent.
For those over 65 the guidelines reverse a controversial adjustment made three years ago that relaxed the standard and the decision not start medicines unless the top number was over 150. Now, everyone over 65 should be treated if the top number is over 130 unless they're too frail or have conditions that make it unwise.
Dr. Jackson Wright, a guidelines panel member from University Hospitals Cleveland Medical Center stated the evidence is so solid and convincing that it's hard to argue with the new levels. Older people have a 35-to-50-fold higher risk of dying of a heart attack or stroke compared to younger people. Duh...no kidding. Cleveland Clinic's Dr. Steven Nissen said he's worried because more vulnerable patients who get treated very aggressively may have trouble with falls because too-low pressure can make them faint.
The decision as to whether to start medication will no longer be based just on the blood pressure, but should consider the overall risk of having a heart problem or stroke in the next 10 years, including factors such as age, gender and cholesterol. Unless one has high risk factors the advice is to improve lifestyle: lose weight, eat healthy, exercise more, limit alcohol, avoid smoking. There's not enough proof that consuming garlic, dark chocolate, tea or coffee helps, or that yoga, meditation or other behavior therapies lower blood pressure long-term.
One might be skeptical of these new guidelines because they mean more money for doctors and the drug companies now that more people will be diagnosed with high blood pressure. On the positive side, the U.S. government no longer writes heart guidelines, leaving it to medical people. It's claimed that unlike previous guideline panels, none on this new study have recent financial ties to industry, although some on a panel that reviewed and commented on them do. While it can't be argued that lower is better, this alone is cause for suspicion.