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Less than 130/80 is the new goal

The American College of Cardiology and American Heart Association released the new guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults.

These were published in the Nov. 13 issue of the Journal of American College of Cardiology authored by Whelton PK et al. The new categories for blood pressure are:

Normal blood pressure: Systolic blood pressure less than 120 mm Hg and diastolic blood pressure less than 80 mm Hg

Elevated blood pressure: Systolic blood pressure 120-129 mm Hg and diastolic blood pressure less than 80 mm Hg

Stage 1 Hypertension: Systolic blood pressure 130-139 mm Hg or diastolic blood pressure 80-89 mm Hg

Stage 2 Hypertension: Systolic blood pressure 140 mm Hg and above or diastolic blood pressure 90 mm Hg and above

Individuals with systolic and diastolic blood pressures in two categories are designated to the higher blood pressure category.

Compared to the old classification used since 2003 and the JNC 7 and JNC 8 in 2014, the new guidelines lower the definition of high blood pressure from 140/90. What are the reasons for lowering target blood pressure? One is that at stage 1, the risk of developing heart attack or stroke (termed cardiovascular complications) is doubled. Studies show that setting lower BP goals reduce the risk for these complications.

Other highlights of the new guidelines are the following:

1. It is important that standards for accurate blood pressure measurements be followed. An average based on two or more readings obtained on two or more occasions are used to estimate the individual’s level of BP. Out-of-office and self-monitoring of BP are recommended to confirm the diagnosis of hypertension and to guide BP-lowering medication.

2. Corresponding BPs based on site/methods are: office/clinic 140/90, home blood pressure monitoring 135/85, daytime ambulatory blood pressure monitoring (ABPM) 135/85, night-time ABPM 120/70, and 24-hour ABPM 130/80 mm Hg. In adults with an untreated systolic BP (SBP) >130 but <160 mm Hg or diastolic BP (DBP) >80 but <100 mm Hg, screening for the presence of white coat hypertension using either daytime ABPM or HBPM prior to diagnosis of hypertension is needed. In adults with elevated office BP (120-129/<80) but not meeting the criteria for hypertension, screening for masked hypertension with daytime ABPM or HBPM is reasonable.

3. Two or more medications combined in one pill/tablet improve compliance and consistency in blood pressure control.

4. Socio-economic status and psychosocial stress are recognized as risk factors for high blood pressure and are considered when planning a hypertensive person’s treatment.

The new guidelines provide recommendations applicable to patients who are at risk of developing hypertensive complications. Although the focus of these guidelines is on medical practice in the United States, they were developed in collaboration with other organizations so they can have an impact on medical practice in other countries as well. They can affect how doctors, health care providers, insurance, and other agencies formulate treatment plans and policies. They are meant to guide decisions to improve patient care and meet patient’s interests. The guidelines are not meant however to replace your doctor’s sound judgment so while it is true that target blood pressures are set, your doctor will not rapidly lower your blood pressure to less than 130/80 to meet the new goal. Your doctor considers your age, past history, presence of co-morbid conditions (co-existing illnesses) like asthma, diabetes mellitus, kidney function impairment, and heart disease. Also other medications you are currently taking. In other words, your doctor will individualize and tailor your treatment according to your distinct history and medical condition.

And before putting you on any drug therapy, these modifiable risk factors – factors that can be changed – are managed or addressed first:

1. Current cigarette smoking, secondhand smoking

2. Diabetes mellitus

3. Dyslipidemia/ hypercholesterolemia – elevated blood cholesterol levels

4. Overweight/obesity

5. Physical inactivity/low fitness

6. Unhealthy diet

7. Psychosocial stress

8. Sleep apnea

Medical concerns and questions may be emailed to or yourmedicalcorner@yahoo.com.

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