The United States has updated its guidelines for managing high blood pressure, aiming to reduce the risks of heart disease and dementia more effectively than ever before. This revision follows a comprehensive review of recent research on hypertension and replaces the previous guidelines established in 2017. The new recommendations are the result of collaboration among the American Heart Association (AHA), the American College of Cardiology (ACC), and other esteemed institutions.
The updated guidelines primarily modify existing recommendations for healthcare professionals, particularly targeting individuals at higher risk, those with specific medical conditions, and pregnant women. While the guidelines focus on these groups, they remain relevant to everyone, regardless of their current health status.
New Tools for Risk Assessment
A notable addition to the guidelines is the introduction of the PREVENT (Predicting Risk of CVD Events) score, a cardiovascular risk calculator developed using data from 3.2 million individuals collected between 1992 and 2022. This tool is designed to enhance risk assessment for a wider array of potential health issues linked to high blood pressure.
Research increasingly indicates that high blood pressure elevates the risk of various cardiovascular and neurological diseases, as well as complications affecting the kidneys, eyes, and metabolic health. According to the updated guidelines, “High blood pressure is the most prevalent and modifiable risk factor for the development of cardiovascular diseases, including coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, chronic kidney disease, and all-cause mortality.”
Blood pressure is measured in two values: systolic blood pressure (the pressure during heartbeats) and diastolic blood pressure (the pressure between heartbeats). The guidelines maintain established thresholds for hypertension, which define normal blood pressure as below 120 mm Hg systolic and below 80 mm Hg diastolic. Elevated blood pressure is categorized as 120-129 mm Hg systolic and below 80 mm Hg diastolic.
Understanding Blood Pressure Stages
High blood pressure is classified into two stages. Stage 1 is defined as 130-139 mm Hg systolic or 80-89 mm Hg diastolic, while Stage 2 consists of readings exceeding these figures. Blood pressure readings surpassing 180 mm Hg systolic or 120 mm Hg diastolic warrant immediate medical attention, especially if accompanied by symptoms like chest pain or shortness of breath.
Once diagnosed with high blood pressure, healthcare providers may need to prescribe medication. Notably, European guidelines typically do not initiate treatment until a threshold of 140/90 mm Hg is reached, barring other health considerations.
The guidelines emphasize that the primary treatment goal for adults is to achieve a blood pressure below 130/80 mm Hg. Special considerations apply for individuals requiring institutional care, those with a limited predicted lifespan, and pregnant women.
Lifestyle recommendations remain consistent and are applicable to everyone. These include maintaining regular physical activity, adhering to a diet low in sodium, moderating alcohol intake, and managing stress levels to help lower blood pressure. Social support from friends and family can also play a beneficial role.
The guidelines advocate for clinicians to collaborate with community leaders and health systems to implement comprehensive screening for high blood pressure in all adults and apply evidence-based recommendations for prevention and management.
The new guidelines were published in the journals Hypertension and Circulation, marking a significant step towards improved management of hypertension and its related health risks.
