Why do 10 million additional Americans suddenly have high blood pressure?

For the first time in 15 years, the American Heart Association and the American College of Cardiology have changed the definition of high blood pressure.

Now, millions more Americans have the diagnosis. If your BP is 130-139 over 80-89, you have hypertension under the new guidelines. A reading of 140 over 90 or higher is considered stage II hypertension.

Previous guidelines were about 10 points lower.

The CDC estimates 75 million Americans have high blood pressure. The new guidelines are expected to bump that number up by almost 14 percent, or 10 million people.

Annals of Internal Medicine published a paper Monday by Drs. Robert Carey and Paul Whelton of University of Virginia Health System reacting to the changes.

In the paper, they explain that more and more research points to elevated cardiovascular risks with readings of 130 over 80 and higher. High blood pressure, also known as “The Silent Killer,” is dangerous for the very moniker given it. Many people are unaware of their high BP until a dangerous or even deadly cardiovascular event.

However, regardless of whether doctors use medications to treat a patient’s high blood pressure, the guidelines say that lifestyle changes need to be the first line of attack.

Those lifestyle changes include:

Giving up cigarettes and minimizing or eliminating alcohol use 

Being checked regularly for diabetes 

Exercising often 

Eating healthy foods including whole grains, fruits and vegetables.

Exercise can be a double-edge sword. For those suffering from anxiety who partake in intense cardiovascular activity, blood pressure actually can go up due to cortisol production.

Some docs believe changes aren’t necessary

In an accompanying editorial in Annals, three doctors take issue with the new guidelines, including two doctors from VA systems.

“Are the harms, costs, and complexity of care associated with this new target justified by the presumed benefits of labeling nearly half the U.S. population as unwell and subjecting them to treatment? We think not and believe that many primary care providers and patients would agree,” they write.

They believe that even though lifestyle changes might be encouraged, in reality the end result could be patients being needlessly put on high blood pressure medications.

“We agree with the ACC/AHA guideline about the importance of a healthy lifestyle; however, this is important for everyone, regardless of BP. Whether categorizing a person as hypertensive per this new definition will improve adherence to lifestyle changes is unknown, but it may shift attention from a healthy lifestyle to pharmacologic therapy. It is important to consider the ramifications of labeling asymptomatic persons as unwell before expanding a disease definition.”

The authors of the editorial believe benefits of lowering the threshold for blood pressure treatment often are overestimated, and harms often underestimated. “Trials mostly enrolled patients with hypertension who were tolerating treatment and used run-in periods to weed out non-adherent persons, including those experiencing harms.

“In addition, the assumption that data from trials in patients with established hypertension applies to newly diagnosed patients is flawed. A trial involving primarily untreated persons with borderline elevated BP found no reduction in cardiovascular events with treatment.”

The important thing to remember is to always listen to your body. But with high blood pressure often having no symptoms, you need to get your blood pressure checked regularly. So-called “white coat” syndrome, where patients become nervous having their blood pressure taken by a doctor, is very real. This can result in a false elevated reading.

For that reason, a blood pressure cuff is a good investment for your home.

Until next time.

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