New blood pressure guidelines trigger rethinking of heart risk

April 27, 2018 Providence Health Team


By changing the ways they evaluate blood pressure, caregivers are addressing risks earlier

Almost half of America's adult population may now be considered at risk - but for many, no additional medications are needed


On one day last fall, you may have been tooling along, comfortable enough knowing your blood pressure, while slightly higher than optimal, was perfectly normal.

But on the next day, you learned that your 130/90 reading puts you in a category of Stage 2 hypertension, which means you have a high risk for heart attack, stroke or full-blown heart disease.

What changed? In November, the American College of Cardiology and the American Heart Association published revised guidelines for evaluating hypertension, declaring “130 is the new high.” That effectively pushed almost half of America’s adult population to a classification of high blood pressure. And that led to a lot of sobering conversations in clinics and physician offices around the country.

Dr. Brydan Curtis, DO, who practices at Providence Spokane Cardiology, said he heard about it from other men exercising at his gym. Generally, they were very active people who were 40 and older. 

“They’d say, ‘My doctor says I have elevated blood pressure. I don’t have high blood pressure,’” said Dr. Curtis. 

That opened the door to conversations Dr. Curtis and many other caregivers have started to have with patients who never considered themselves to be at risk for heart problems. They explain that yes, you may feel perfectly healthy with elevated or high blood pressure, but you are at higher risk of developing health problems in the future, say, 10 years down the road.

“I think patients understand that,” said Dr. Curtis, whose practice focuses on people who already know they may have heart issues. The bulk of the critical conversations, he said, are between patients and their primary care physicians. “Those providers are the first line of defense against heart disease.”

In a nutshell, the new guidelines mean that health care providers and their patients should begin addressing high blood pressure earlier, whether with healthier diets and more exercise, or medication, or both.

What the guidelines say

In essence, the new guidelines lowered the levels considered normal, or healthy, and eliminated the vaguely worded category of “prehypertension.” Instead, people who had been classed as having prehypertension are now considered to have “elevated” blood pressure.

(Credit: American Heart Association)

According to the American Heart Association and the American College of Cardiology, high blood pressure accounts for the second largest number of preventable heart and stroke deaths, after smoking. Dr. Paul Whelton, MD, lead author of the article announcing the new guidelines, described the change as providing many people with “a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

People with elevated blood pressure or Stage 1 hypertension should seek to exercise most days, reduce their salt intake, quit smoking and lose weight, according to the two organizations. Only a small proportion of people newly classified with high blood pressure will need medication, they said.

People with Stage 2 hypertension will require more aggressive treatment, including medication.

Either way, people with higher-than-normal blood pressure readings should have conversations with their providers.

Monitoring blood pressure

The new guidelines also highlight the importance of checking blood pressure regularly. This can be done with approved devices in medical clinics or at home. But, because individual readings can vary according to circumstances, people should take several readings over time. 

The new guidelines have helped heighten awareness of the risks associated with high blood pressure, said Dr. Curtis.

“It gives me more ammunition to communicate to patients what the goals are for them,” he said. This often means making incremental, rather than sudden changes to lower risks. Dr. Curtis says he tells patients “We’re trying to get your blood pressure to normal.”

So check your blood pressure. You can get your readings taken at any Providence clinic or office. To find a Providence provider near you, consult our online directory.

Read more of our articles about heart health.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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