Hands using blood pressure cuff

Has your once-acceptable blood pressure suddenly been recast as "high"?

If so, you're among 1 in 7 Americans who suddenly find themselves on the wrong side of an important dividing line, thanks to new blood pressure guidelines recently set by the American Heart Association (AHA) and the American College of Cardiology.

And if so, you may want to make an appointment with your doctor.

Before, a blood pressure of 140/90 mm Hg was the threshold of "high." Now, that standard has been lowered to 130/80.

Thanks to that change, now nearly half of all adults — 46 percent, to be exact — have high blood pressure.

The new guidelines are the first comprehensive, new blood pressure guidelines to be set in 14 years.

One of the committee members who helped write the new guidelines is Sandra Taler, a professor of medicine and staff consultant at Mayo Clinic in the division of nephrology and hypertension.

Besides lowering the definition of high blood pressure, the new guidelines also dispose of the old "pre-hypertension" category, formerly used to describe patients between a 120 and 139 systolic blood pressure.

Instead, the new categories are as follows, according to the American Heart Association:

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.

Clearer categories

The "elevated" stage, which replaces the term "pre-hypertention," may make it clearer to patients that their blood pressure is no longer considered "normal" when it rises above 120, Taler said.

"The intention was to make people think about hypertension and not just (say), 'Oh, this is OK,'" Taler said. "Prehypertension may be stronger, but prehypertension just didn't work. You know, you're pre-dead. Everybody is pre-dead. It did not get people thinking, 'I'm really at risk here and I need to change my ways.'"

Most people should still be able to treat their blood pressure without medication, Taler said — especially if a risk assessment is done and the threat of heart disease is less than 10 percent.

However, those changes are not as simple as "not salting your egg on Sundays," Taler said.

Learning to cook to avoid excess salt, eating less and exercising to lose weight can bring a patient's numbers down.

As 140 and higher is now considered stage 2 hypertension, Taler said medication will be used more often in conjunction with lifestyle changes.

Permanent change

Taler said she's used to patients who are skittish about going on medication that they may take for the rest of their lives.

If a patient responds well to medication and lifestyle changes, though, she tells them they may be able to reduce their medication and monitor their blood pressure. As long as it stays within the target area, they're golden.

"But if you stop those efforts — you get busy, you start traveling, you don't watch your salt anymore, you gain back some weight — then you're very likely to have to go back on medication, since those lifestyle changes are what's treating your blood pressure," she said.

Dana Baker is familiar with the anxiety that comes with beginning medication.

Baker is an employee at the Florida Mayo Clinic, working in corporate relations for executive health.

"I was in my 30s, and a little overwhelmed by, 'What is high blood pressure? Does it mean anything?'" Baker said.

After being diagnosed with high blood pressure — 150/100 — 10 years ago, Baker began trying to improve her blood pressure using diet and exercise. She lost some weight, but wasn't able to lower her blood pressure until she found the right medicine.

And she wasn't fully convinced until her physician plugged her numbers into the risk assessment, which showed that she had a 30 percent chance of developing heart disease.

A few days after the new guidelines came out, she had her blood pressure checked: 125/80.


Baker also is used to monitoring her own blood pressure outside of the doctor's office. She was asymptomatic and has a "good BMI," so she first purchased a wrist cuff to check her own blood pressure and ensure her measurements weren't just "white coat syndrome."

Since then, Baker has gotten a cuff that fits to her upper arm to keep track of her own blood pressure. She advises other patients with high blood pressure to research the options, then pick one that is accurate, and which they'll actually use.

"The doctor takes your blood pressure in the office, and it's a little intimidating to think about getting a blood pressure cuff that looks like the one that's in your doctor's office and knowing what to do with it," Baker said. "You have this big old machine on your desk. But it is good — (when) you have your physical, you need to show where your numbers are, not just the number that you have the day that you go in."

Not everyone needs an at-home monitor, Taler said. People with normal blood pressure can get measurements once or twice a year at checkups.

When a patient gets into the "elevated" range, though, "it would be reasonable to measure it at home," she said.

"Some people are higher at the doctor's office, some people are higher at home (or) may be higher at work," she said.

Having a machine at home isn't always reliable — they're not checked often, so Taler doesn't recommend them as the only screening option.

However, home readings can provide a body of evidence that helps smooth out the natural variability of blood pressure readings.

"Blood pressure is pretty variable, and one elevated reading isn't enough to say, 'You need medicine' or 'You need more medicine,'" Taler said. "We really need to see a pattern."

Updated standards

There had been no update to the blood pressure guides since 2003, even though many studies had been published since.

In 2014, work began on a complete update of the U.S.'s definition of hypertension and treatment guidelines. During the writing period, the Systolic Blood Pressure Intervention Trial ended.

The SPRINT studied more than 9,000 people with blood pressure of 130 or higher systolic. They were assigned randomly to one of two groups — one that aimed for a blood pressure under 120 after treatment, and a second that aimed for 140 or lower.

After a little more than three years, the study ended because the members in the second group had about 25 percent higher odds of developing cardiovascular disease. About 8 percent of the patients in the 140 group developed a cardiovascular event — a heart attack or other health issue. About 6 percent of the lower group did.

Criticisms have been leveled at the study for its seemingly low significance — but Taler argues it still is significant.

"It's hard to argue with the results — they were true for older people, they were true for people with kidney disease, they were particularly true for people who had evidence for cardiovascular disease or were high-risk for cardiovascular disease," she said. "And particularly the elderly group, where people are worried about lowering their blood pressure too much, it showed benefit."

The SPRINT trial was not the entire basis for the new guideline. A meta-analysis of other studies since 2003 showed benefits to lowering blood pressure further than 140/90.

Some pushback against the new guidelines has accused the writers of trying to create more of a market for blood pressure drugs, Taler said.

By design, no one on the committee worked for drug companies or in pharmacology, she said. And although they do talk about generic drug treatments, the focus of the guidelines is on lifestyle changes, which she calls "the first line of treatment."


Tips for self-checks

American Heart Association News provides the following tips for taking blood pressure:

• Take two readings. It reduces variability.

• Avoid smoking, caffeine and exercise in the 30 minutes before you take your blood pressure.

• Sit still for five minutes beforehand.

• Keep your cuffed arm on a flat surface, such as a table, at heart level. Sit upright, with your back straight and head up.

• Don't talk during the test.

• Wait one minute and retake the test. Keep a log, and bring it with you to doctor's appointments.

More information:

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Anne writes for Rochester Magazine and the Post Bulletin, and edits 507 Magazine. She hails from Lafayette, Indiana and enjoys reading, tea-drinking, and her cat, Newt Scameownder.