Wisdom Wednesday: Definition of High Blood Pressure Drops

Nearly half of all adult Americans will be considered to have high blood pressure under new guidelines issued Monday by the nation’s top health organizations.

The new guidelines lower the diagnostic threshold for stage 1 high blood pressure to 130/80, down from the previous level of 140/90, according to a joint statement from the American Heart Association and the American College of Cardiology.

Further, the guidelines also call for more aggressive treatment of high blood pressure, asking doctors and patients to set 130/80 as the new goal of therapy.

High blood pressure can lead to heart attacks, strokes and heart failure.

But the guidelines also press for more judicious treatment of high blood pressure – sometime called hypertension – and an emphasis on lifestyle risk factors. Prescriptions for blood pressure drugs are not expected to leap under the guidelines, experts said.

The two heart organizations announced the new guidelines Monday at the American Heart Association’s annual meeting, in Anaheim, Calif. The guidelines were last revised in 2003.

This change means that 103 million Americans well be considered to have high blood pressure, or about 46% of the adult population, said Dr. Paul Whelton. He is chair of the 2017 Hypertension Practice Guidelines and a professor of Global Public Health at Tulane University School of Public Health and Tropical Medicine in New Orleans.

The impact of the new guidelines is expected to be greatest among younger people. High blood pressure is expected to triple among men under age 45 and double among women under 45, according to the guidelines report.



However, only about 30% of people with stage 1 high blood pressure under the guidelines will require drug therapy, Whelton said. That’s because everyone with stage 1 high blood pressure will be evaluated for heart disease. Only those with heart disease or at high risk for developing it during the next decade will be prescribed drugs, the guidelines state.

The rest of those at risk under the new guidelines will be urged to reduce their blood pressure through lifestyle changes – losing weight, eating healthful foods, cutting down on salt, increasing potassium-rich foods, exercising regularly and moderating their drinking, said Dr. Bob Carey. He is vice chair of the 2017 Hypertension Practice Guidelines and dean emeritus of the University of Virginia School of Medicine.

The experts estimate “a projected increase in patients with stage 1 hypertension requiring drug therapy of 1.9%,” Carey said. “This amounts to 4.2 million people, based on the U.S. population.”

My Take:
This reminds me too much of the criteria for statin drugs. Originally, statin drugs were indicated when your cholesterol was over 240 and you had other risk factors. Today, drug therapy is often started when cholesterol exceeds 200. There is little or no emphasis on lifestyle changes. Now over 50% of the adult population qualifies for statin drug therapy. When confronted with the fact that more than 50% of patients having their first heart attack have normal or low cholesterol, the response is “see, they should be on statin drugs as well”.

The Bottom Line:
The new criteria may be well intentioned and I agree with exercise, diet and healthy lifestyle changes to reverse high blood pressure. I think most physicians will just start prescribing calcium channel blockers, beta blockers and ACE inhibitors sooner. I predict the number of prescriptions for hypertension will skyrocket in the next few years.

Source: November 13, 2017 National Institutes of Health