The goals that are right for you, and how to meet them
In the past two years or so, many Americans suddenly found themselves faced with hypertension. For some 31 million, it wasn’t an abrupt surge in blood pressure that put them in that category. It was the result of a new definition of high blood pressure from the American Heart Association (AHA) and the American College of Cardiology (ACC) in 2017.
Before then, blood pressure was considered borderline-high at 140/90. (The systolic number is the top one; the diastolic, the bottom.) Now, a measurement as low as 130/80 is considered stage 1 hypertension.
Some experts say that redefining hypertension offers significant benefits. “There’s a lot of therapeutic inertia in medicine, which means a lot of physicians were just shrugging their shoulders when patients were coming in with blood pressure readings of 135/85 instead of sitting them down and counseling them about their measurements,” says Luke Laffin, M.D., a preventive cardiologist at the Cleveland Clinic. “When you label it hypertension, both physicians and patients are more likely to take notice and act on it.”
A 2019 study in the journal Circulation estimated that if all adults in the U.S. ages 45 and older who met the criteria for taking blood pressure meds kept their levels below 130/80, we’d see 3 million fewer strokes, heart attacks, and episodes of heart failure over a decade.
But right now, more than half of Americans who take medication for hypertension still have blood pressure that’s too high—over 130/80, says Paul Muntner, Ph.D., a professor of epidemiology at the University of Alabama at Birmingham.
One possible reason is that not all healthcare providers have adopted the 2017 guidelines, although the AHA and ACC recently released 22 “clinical performance and quality measures” in part to help encourage that. And there’s continuing debate among cardiologists and primary care doctors about when medication should be prescribed and whether there should be more wiggle room for target blood pressure levels for older adults.