Is High Blood Pressure on the Rise?

December 06, 2017

Nearly half of US adults have high blood pressure according to new AHA guidelines

If you recently had your blood pressure checked, and were told you were ok, you may in fact be among the 50 percent of Americans who have high blood pressure according to new guidelines set by The American Heart Association. These new guidelines lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition, which now affects nearly half of adults in the United States.

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. The top number is your systolic blood pressure. (The highest pressure when your heart beats and pushes the blood round your body.) The bottom one is your diastolic blood pressure. (The lowest pressure when your heart relaxes between beats.)

The guidelines set the following new categories:

  • Normal: Under 120 over 80
  • Elevated: Top number 120-129 and bottom less than 80
  • Stage 1: Top of 130-139 or bottom of 80-89
  • Stage 2: Top at least 140 or bottom at least 90

Shore Physicians Group Hospitalist Dr. Ankit Malik was not surprised by the new guidelines and is supportive of the new terminology being used.

“Hypertension is an independent risk factor for cardiovascular events, including strokes,” explained Dr Malik. “For every 20 mm hg increase in systolic blood pressure, your risk is doubled.  So, though the increase in risk from a rise of 115 to 135 is small, as you continue to go higher – at 175 you are at 8x greater risk. The new guidelines are stricter, which is a good thing.”

The new guidelines also call for replacing the term "Prehypertension" with “Elevated Blood Pressure”

“I agree with the terminology change,” continued Dr. Malik. “The word ‘prehypertension’ was not strong enough to cause people to take action. Using ‘elevated blood pressure’ removes some of the false sense of security people who were at risk were holding onto.”

Blood pressure should be checked at least once a year by a health professional, and diagnosing high pressure requires 2 or 3 readings on at least two occasions. Locally, Shore Medical Center and Shore Physicians Group offers free blood pressure screenings at a number of community health fairs, including Somers Point’s Bayfest in April, the AC Weekly Health Fair in Ocean City in September among others. You can also take advantage of testing machines at local pharmacies, and you contact your primary care physician.

The change in guidelines 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 and live healthier lifestyles. Poor diets, lack of exercise, smoking, and other bad habits cause 90 percent of high blood pressure.

That means 46 percent of U.S. adults have high pressure (stages 1 or 2) versus 32 percent under the old levels. How common it is will roughly triple in men under 45 and double in women of that age.

For people over 65, the guidelines undo a controversial tweak made three years ago to relax standards and not start medicines unless the top number was over 150. Now, everyone of that age should be treated if the top number is over 130 unless they're too frail or have conditions that make it unwise.

While anyone can develop high blood pressure, factors such as age, gender, race or ethnicity, and family history can increase one’s risk. According to the National Heart, Lung, and Blood Institute, high blood pressure is more common among African American adults, more common among men before age 55, and more common among women after age 55.

Certain groups, such as those with diabetes, should be treated if their top number is over 130, the guidelines say. For the rest, whether to start medication will no longer be based just on the blood pressure numbers. The decision also 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, using a simple formula to estimate those odds.

The guidelines were published in two journals — Hypertension and the Journal of the American College of Cardiology. Portions of this article were published by the Associated Press on November 13, 2017.