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What’s Your Number? New Blood Pressure Guidelines Impact Millions

Posted by Emerald Coast Medical Association on Aug 10, 2018 8:30:00 AM

On August 1st, the American Heart Association and the American College of Cardiology released updates to their guidelines for the prevention, detection, and management of high blood pressure. This is the first change to this guidance in 14 years and means that nearly half of all Americans, 46%, now classify as having high blood pressure.

Stage 1 Hypertension is now defined as a systolic reading of 130-139 and/or diastolic measurements of 80-89. Previously, it was considerably higher, at 140/90 mm Hg and up, and these new numbers are in response to proof that complications can occur at those lower numbers as well.

Additionally, the category “Pre-Hypertension” has been eliminated, now the lower numbers are redefined as “Elevated” for the bottom of the range or “Stage 1 Hypertension” for the upper end, while the former Stage 1 and Stage 2 have been merged into “Stage 2 Hypertension.”

Hypertensive Crisis is the label for systolic blood pressure over 180 and/or diastolic over 120. Patients diagnosed with this condition will need immediate hospitalization if there are signs of organ damage, at a minimum. If they have no other problematic indicators, their medication should be changed right away in an effort to bring their pressure out of the danger zone.

Given these new guidelines, about 4.2 million people will be newly diagnosed with high blood pressure even though their blood pressure has not increased. That said, only about 1.9% will be advised to start taking medication for their diagnosis. The guidance recommends that patients diagnosed with elevated BP or Stage 1 hypertension should be counseled to change their lifestyle rather than medicated. Proven methods of lowering blood pressure include more exercise, cutting sodium intake, and consuming healthier foods, such as produce and whole grains, should be the first line of defense.

“This is not a document to say, ‘What’s your number and are you above it or below it?’” says Don Casey, MD, MPH, MBA, Senior Vice President and Chief of Clinical Affairs for Medecision, “We wanted to take a look at all the existing and current evidence around hypertension related to BP and risks, classification of BP, measurement of BP, causes of hypertension, non-pharmaceutical interventions, patient evaluation, and more.”

The new guidance encourages prescribing medication for Stage 1 hypertension only if the patient has already had a cardiovascular event or is in a high risk category for other reasons, such as age, diabetes, or kidney disease. It also states that “invisible” risk factors,  socioeconomic status or psychosocial stress for example, be considered when creating the patient’s care plan. The overarching goal of these new guidelines is prevention and early intervention, in the hopes that major hypertensive events can be reduced with proactive behavior from both the doctor and the patient.

Emerald Coast Medical Association is here to partner with you as you navigate the ever changing landscape of American healthcare. We know it can be challenging to stay abreast of breaking news and changes that affect your practice. We aim to assist you by gathering information as it comes and share it with our members at our monthly meetings and here on our site.

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