Revised blood pressure guidelines affect millions

Under new criteria, nearly half of American adults would have high diagnosis

Tens of millions more Americans will qualify for a diagnosis of high blood pressure and will need to change their lifestyles or take medicines for the condition under new medical guidelines released Monday.

The guidelines, formulated by the American Heart Association and the American College of Cardiology, sharply lower the threshold for normal blood pressure, in effect moving the goalposts for patients nationwide.

The new criteria, the first official diagnostic revision since 2003, result from growing evidence that blood pressure far lower than once was considered normal reduces the chances of heart attack and stroke, and lowers the risk of death.

New research indicates this is true even among older people for whom intensive treatment had been thought too risky.

Now, high blood pressure, or hypertension, will be defined as 130/80 millimetres of mercury or greater for anyone with a significant risk of heart attack or stroke. By those crite- ria, nearly half of all American adults, and nearly 80 per cent of those ages 65 and older, will need to take steps to reduce their blood pressure. The number of Americans with high blood pressure, or hypertension, will rise to 103 million from 72 million under the previous standard, said Dr. Robert Carey, professor of medicine at the University of Virginia and co-chair of the committee writing the new guidelines. The number of men younger than 45 with a diagnosis of high blood pressure will triple. The prevalence of high blood pressure among women younger than 45 will double.

Only those at highest risk, an additional 4.2 million people, will need drug therapy, Carey said.

“Those numbers are scary, except we recommend lifestyle changes for the vast majority,” he said.

The previous guidelines defined high blood pressure as 140/90.

High blood pressure is second only to smoking as a preventable cause of heart attacks and strokes, and heart disease remains the leading killer of Americans.

The guidelines suggest starting drug treatment with the aim of getting blood pressure below 130/80 for anyone with at least a 10 per cent risk of a heart attack or stroke in the next decade.