Do You Have High Blood Pressure? What the New Guidelines Say.

Kerri Costa, RN, BSN

Your blood pressure is an important part of your overall health.

But what is it? Blood pressure is the force of the blood pushing against the walls of your blood vessels. If it is too high, it can put a strain on your heart and blood vessels, and can lead to increased risk of heart disease and stroke.

Your blood pressure is measured using a device called a sphygmomanometer – that cuff that goes around your arm. The measurement then indicates a unit of pressure known as millimeters of mercury (or mm Hg). It shows how hard your heart is working to pump blood.

Your blood pressure is written as two numbers. The top number, known as the “systolic pressure,” measures the force of the blood against the artery walls when the heart contracts to pump blood out. It is working its hardest at that point.

The bottom number is the “diastolic” pressure, which shows the force of the blood when the heart is “resting” in between contractions. That number is lower.

Doctors use standard guidelines to determine if your blood pressure falls into a range known as “normal.” If it is too high and is consistently higher than the guidelines, it known as “hypertension.”

What are the dangers of high blood pressure?

High blood pressure, or hypertension, is known as the “silent killer.” This means it does not have any symptoms and can go untreated for a long time, which can lead to many major health risks. If left untreated, a blood pressure of 180/120 or higher results in an 80% chance of death within one year, with an average survival rate of ten months. Prolonged, untreated high blood pressure can also lead to heart attack, stroke, blindness, and kidney disease.

Out with the old

Since 2003, the guidelines for diagnosing and treating high blood pressure were:

  • normal: less than 120/80 mm Hg
  • pre-hypertensive: systolic between 120-139 or diastolic between 80-89
  • stage 1 hypertension: systolic 140-159 or diastolic 90-99
  • stage 2 hypertension: systolic 160 or higher or diastolic 100 or higher
  • hypertensive crisis: systolic 180 or higher or diastolic 110 or higher

In November 2017, the American Heart Association and the American College of Cardiology revised the guidelines. They are:

  • normal: less than 120/80 mm Hg
  • elevated: systolic between 120-129 and diastolic less than 80
  • stage 1 hypertension: systolic between 130-139 or diastolic between 80-89
  • stage 2 hypertension: systolic at least 140 or diastolic at least 90 mm Hg
  • hypertensive crisis: systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

What is the difference?

The major difference between the old and new guidelines is the elimination of the category of “pre-hypertension.” However, findings from research studies show that complications can exist when blood pressure is as low as 130-139 over 80-89.

The new guidelines change the categories. Those same readings that would have been pre-hypertension are now categorized as stage I hypertension. Doing so means earlier treatment, which can help prevent future increases in blood pressure and more serious complications associated with hypertension.

What does it mean if you fall into the new guidelines?

With these new guidelines, it is estimated that about 14 percent of people will now be classified as having hypertension; many of those individuals may be younger. However, only a small percentage will require intervention by medication. Individuals who now fall into a hypertensive category will receive more aggressive prevention interventions, like lifestyle changes.

What can I do to lower my blood pressure?

There are things we can all do to help control blood pressure. These “lifestyle modifications” are changes you can make in your daily life.

  • Follow the Dietary Approaches to Stop Hypertension, or DASH diet. This includes fruits, vegetables, whole grains, and low-fat dairy products with reduced saturated and total fat.
  • Increase your physical activity. Add 90 to 150 minutes each week of aerobic exercise. Also, include three days of strength training each week. Not only can this help reduce or control your blood pressure, but it can also help with weight management. In overweight individuals, a weight loss of even five to 10 percent has been shown to reduce blood pressure.
  • Decrease your sodium to no more than 1500 milligrams each day. Less is even better. Experiment with spices instead of adding salt to your food.
  • Limit your alcohol. It is recommended that men have no more than two drinks per day and women have no more than one to help control blood pressure.
  • Manage your stress. Because stress can have a major impact on our bodies, it is important to have an effective coping technique. There are many techniques for relaxation.
  • If you smoke, quit. Quitting smoking can have a huge impact on your health.

These are some of the most proactive ways one can support a normal blood pressure and an overall healthy life. But sometimes, even a healthy lifestyle is not enough to maintain a safe blood pressure. When lifestyle modifications do not lower blood pressure to better levels, medication can be prescribed.

Again, the guidelines come into play because your doctor will prescribe an appropriate medication based on your blood pressure category. That determines how often you need to be seen to have your blood pressure checked and what medication is needed. Sometimes, more than one medication is necessary. Some patients may need more frequent monitoring. Anyone with a blood pressure reading in the “crisis” stage will be given immediate medical attention.

Be good to yourself, and try to keep your blood pressure in that normal range by living a healthy lifestyle. Your heart will thank you!