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New Hypertension Guidelines

Months prior to the death of President Franklin D. Roosevelt in 1945 from a massive stroke, the former president was given a clean bill of health with a blood pressure reading of 220/120. Shortly thereafter the relationship between hypertension (high blood pressure) and risk for heart disease and stroke was established and guidelines for the definition, diagnosis, and treatment of hypertension began to emerge. Hypertension awareness and treatment has come a long way since then. Now for the first time in 14 years, those guidelines have been updated and there is a new definition of hypertension.


The new guidelines, developed by the American Heart Association, the American College of Cardiology and nine other health professional organizations were released on November 13th. The most significant change is that high blood pressure is now defined a systolic number above 130 or a diastolic above 80. The systolic (top) number is the pressure or force in the arteries when the heart beats, and the diastolic (bottom) number is the pressure measured between heartbeats. The definition for hypertension previously was defined as a systolic number above 140 or a diastolic number above 90.


Why the change?


The recognition that those with blood pressures between 130-139 or 80-89 (previously defined as pre-hypertension) are at a much higher risk than previously thought. According to Paul K. Whelton, M.D. M.Sc., lead author of the guidelines, at those levels “you’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure. You want to be straight with people-if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it is the yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”


Blood Pressure categories in the new guidelines are:

  • Normal:  Less than 120/80 mmHg (systolic number/diastolic number)
  • Elevated:  Systolic number between 120-129 and diastolic number less than 80
  • Stage 1 Hypertension:  Systolic between 130-139 or diastolic between 80-89
  • Stage 2 Hypertension:  Systolic at least 140 or diastolic at least 90



The new definition will mean that 46% of the adults in the US have hypertension, up from 32%. Fortunately, since the treatment for those in the new Stage 1 hypertension category will emphasize lifestyle changes such as:


  • Lower sodium
  • Plant-based diet (DASH Diet)
  • Regular exercise
  • Moderate weight loss
  • No smoking
  • Less than one drink for women or 2 for men per day
  • Stress management


What does this mean for you?


If you have already been diagnosed with hypertension, nothing. Keep working hard to manage your blood pressure by the lifestyle recommendations mentioned above and if prescribed, taking your medications consistently. But if your doctor has made comments such as, “your BP has been creeping up” or “let’s keep an eye on your blood pressure,” make an appointment and find out if you need to take a more aggressive approach to manage your blood pressure. In the meantime, if you have become lax in following lifestyle guidelines listed above, pick one, start working on it, and you will already be moving in the right direction.