February 5, 2018
In November 2017, the American Heart Association (AHA) and the American College of Cardiology (ACC) issued new guidelines for evaluating blood pressure in adults, lowering what was once considered to be the normal blood pressure range. This change got a lot of attention in the news, with headlines stating that millions of Americans would now be classified as having high blood pressure when they were previously in the normal range. Under the new guidelines, approximately 46 percent of U.S. adults will now have high blood pressure (also known as hypertension) and “the prevalence of high blood pressure is expected to triple among men under age 45 and double among women under 45.”1
This is a big change for a lot of people in terms of how they think about their blood pressure and health. But before diving any deeper into the new guidelines, let’s start with a blood pressure 101. We asked Dr. Pangburn to walk us through blood pressure basics to better understand what blood pressure is and why it’s so important to our health.
Blood Pressure 101
Q: What is blood pressure and why is managing it so important?
Pangburn: Well, the text book definition of blood pressure is the measurement of how hard your heart has to pump blood against your arteries as it moves through your body. Blood pressure naturally rises and falls throughout the day, but sustained, elevated blood pressure can lead to serious health risks such as heart attack and stroke. High blood pressure has always been referred to as “the silent killer” because patients with high blood pressure typically don’t show symptoms for years while damage is being done. It’s a risk indicator for much more serious health conditions, which makes managing it so important.
Q: How is blood pressure measured?
Pangburn: This is a simple question with a long answer. As I said before, our blood pressure rises and falls throughout the day, but stressful situations – such as being late or white-coat hypertension (which is just a fancy way of saying that someone’s blood pressure may be elevated because they’re nervous about visiting the doctor) – can also cause a person’s blood pressure to rise.
This is why, as healthcare professionals, we can’t just rely on one blood pressure reading to give us accurate results. The new blood pressure guidelines are actually really specific about this, recommending a minimum of two or more blood pressure readings in a recent time frame of each other and also recommending that one of those readings take place at home using an appropriate device.
But with all that said, blood pressure is typically measured with a sphygmomanometer, commonly known as a blood pressure cuff. If you’ve ever been to a doctor’s office or an urgent care center, you’re probably familiar with the cuff they place around your upper arm. The cuff tightens until your circulation is cut off, then a gauge or stethoscope is used to listen to the pulse of the blood as the cuff releases.
Q: What do blood pressure numbers mean?
Pangburn: Well, blood pressure is reported as two numbers: systolic and diastolic. Systolic blood pressure is the “top number” and measures how much pressure your blood exerts against your artery walls when your heart beats. Diastolic is the “bottom number” and measures the pressure exerted against your artery walls when the heart is relaxed in between beats.
Q: How is blood pressure managed?
Pangburn: The first step to managing blood pressure is adopting healthy lifestyle habits. I group these habits into three simple buckets: diet, exercise, and stress management. Here’s a few practical tips from the ACC’s CardioSmart Program:2
- Maintain a healthy body weight.
- Follow the DASH (Dietary Approaches to Stop Hypertension) Diet. This diet incorporates a lot of fruits, veggies, and low-fat dairy.
- Reduce your salt intake.
- Eat lots of potassium-rich foods like bananas and spinach. Potassium is an important mineral that helps our bodies counteract the negative effects of salt.
- Get out there and get moving. Strive for 30 minutes of physical activity per day.
- Cut back on the drinks. Limit alcohol to no more than one drink per day if you’re a woman and two drinks per day if you’re a man.
- Manage your stress levels through meditation, time management, and relaxation techniques.
MedExpress Pro Tip: If you have high blood pressure, aim to consume less than 1,500 mg of sodium per day.
But for some, blood pressure medication may also be necessary. If you have high blood pressure, it’s important to work with your primary care physician to develop a customized management plan.
Q: Are some people more at risk for high blood pressure?
Pangburn: Unfortunately, yes. There are some factors that contribute to an increased chance of hypertension that we can’t control, such as age, race, gender, and family history. Blood pressure increases as we age, particularly for men, who are more likely to develop high blood pressure after age 45, while women are more likely after age 65. African Americans have an increased chance of developing high blood pressure, as well as those with a family history of hypertension. On the other hand, there are a handful of factors that increase the risk of high blood pressure that we can control. If you’re over weight, smoke, drink heavily, or are generally inactive – you’re putting yourself at greater risk.
So now that we have the skinny on blood pressure – what it is, how it’s measured, and how to manage it – let’s get into the nitty gritty of the new blood pressure guidelines.
Understanding the New Blood Pressure Guidelines
Q: Can you give an overview of the changes that were made with the new blood pressure guidelines?
Pangburn: In a nutshell, the definition of high blood pressure was lowered. With this, there have also been some changes to the terminology, so you may hear some new language from your healthcare professionals. Namely, the term “prehypertension” has been replaced with the term “elevated.”1 So moving forward, blood pressure ranges will be:
- Normal – <120 / 80
- Elevated – 120-129 / <80 (previously normal blood pressure)
- Stage 1 hypertension – 130-139 / 80-89 (previously pre-hypertension)
- Stage 2 hypertension - ≥140/ ≥ 90 (previously Stage 1 hypertension)
Q: Why were changes made to the blood pressure guidelines?
Pangburn: It’s about earlier intervention. The healthcare community now knows and understands more about the risks associated with high blood pressure and its relationship to heart and vascular disease. This is the first set of comprehensive updates to blood pressure guidelines since 2003, and it only makes sense that the guidelines should be updated to reflect what we’ve learned – and that’s that there are considerable health benefits to lower blood pressure. In my opinion, the change is a natural and necessary next step to help Americans address and treat high blood pressure earlier to prevent serious health complications.
Q: What does this mean for me and my family when we visit the doctor?
Pangburn: For patients and healthcare professionals alike, I think the new guidelines do more to bring the seriousness of hypertension to the forefront. At MedExpress, one of the very first things we do when a patient visits us is check their vital signs, which includes their blood pressure. If necessary, we can help refer patients to their primary care physician or a specialist for additional blood pressure checks. I think these types of conversations about blood pressure are going to be happening more frequently and earlier than ever before – which is a good thing.
Q: Do you have any other tips or recommendations for someone looking to take charge of their blood pressure?
Pangburn: It’s always important to know your blood pressure numbers and understand your individual risk factors − including age, gender, race, family history, diabetes, and cholesterol. Share this information with your family and children. Have regular conversations about health risk factors that might run in your family, so as children get older, they have a solid understanding of their medical history and whether or not high blood pressure runs in the family.
Answers provided by Thomas (Tom) Pangburn, MD. Dr. Pangburn was a senior medical leader at MedExpress and former emergency room physician. In his free time, he enjoys farming, fly fishing, and spending time with his family.
Medically reviewed by Chris Howard, DO
1 American College of Cardiology: New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. Published Nov. 13, 2017. Accessed Jan. 6, 2018.
2 American College of Cardiology CardioSmart: High Blood Pressure. Last reviewed Nov. 2017. Accessed Jan. 6, 2018.