New Blood Pressure Guidelines – What They Mean for Your Health

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“Your blood pressure is normal.”

You may have heard your doctor or nurse say it. But what is normal?

New blood pressure guidelines were recently released by the American College of Cardiology/American Heart Association Task Force. The goal was to update the prior guidelines released in 2003 by the Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

“In the past, if you were between 120-139 and 80-90, you were considered as having prehypertension,” says Jennifer Beach, MD, a primary care physician at Beth Israel Deaconess Medical Center’s (BIDMC) Healthcare Associates primary care practice. “Now the guidelines separate 120-129 over 80 or more as ‘elevated’ and 130-139 over 80-89 as Stage 1. What was previously Stage 1, more than 140 over more than 90, is now Stage 2. This change was brought about to emphasize the importance of recognizing elevated blood pressures earlier in life and treating them to prevent complications.”

For those who now fall into an “elevated” stage, it does not necessarily mean taking medication will become part of your daily routine.  

“Lifestyle change is recommended for patients who fall between 120-139 over 80-89,” says Dr. Beach. “It can potentially delay or reduce your need for medication. That said, lifestyle changes are often hard to maintain. Realistic goals and expectations are important.”  

The new guidelines suggest medication for Stage 1 hypertension (130-139 over 80-89) only if a patient has already had a heart attack or stroke, or is at high risk of heart attack or stroke based on age, has diabetes, chronic kidney disease, or other risk factors.  

Dr. Beach also stresses the importance of an accurate diagnosis of high blood pressure. Some people who arrive at a doctor’s appointment just got out of stressful, heavy traffic or had a caffeinated beverage, both of which can raise your blood pressure. Some prescription and non-prescription medications can also raise your levels. Others experience “white coat” syndrome, feeling anxious in a medical environment that results in an abnormally high blood pressure.

“I recommend that decisions about treating high blood pressure, by lifestyle or by medication, be made only after several readings which are properly taken and have consistently shown elevated levels,” says Dr. Beach.

Her recommendations for accurate readings include:

• Check your pressure after sitting quietly for five minutes with your back supported and your feet flat on the ground.  
• Make sure the blood pressure cuff is appropriately sized for your arm and placed over bare skin with the arm supported approximately at heart level.  
• Monitor blood pressure at home or use an ambulatory blood pressure device for 24 hours before confirming a new diagnosis of hypertension.

Most importantly, Dr. Beach recommends that patients be honest with their physicians about their lifestyle, including diet, exercise, alcohol consumption, and tobacco smoking habits. If blood pressure medication is prescribed, it’s important to take it consistently.

“Medical knowledge is an evolving science,” says Dr. Beach. “These guidelines are based on the opinions of a wide range of experts based on their interpretation of the best current data available. Like many things in medicine, this may and likely will change again in the future as more studies are done and our understanding of the human condition advances and becomes more sophisticated.”

For more information, visit bidmc.org.