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Based on the lower thresholds of the blood pressure guidelines updated in late 2017, more American adults are being told that they have high blood pressure. And those who are already being treated for it are discussing with their healthcare providers whether they should adjust their target blood pressure readings.


New Definitions


The cut points that tell us who has elevated blood pressure and who has high blood pressure — also called hypertension — have changed. Stage 1 high blood pressure is now defined as 130/80 mmHg or greater.


The biggest change in the guidelines is a new way of grouping blood pressure categories. Overall, a lower blood pressure target is recommended and has been shown to improve heart health. For example, people who were told they had prehypertension with a systolic pressure (top number) from 120 to 139 mmHg or a diastolic pressure (lower number) from 80 to 89 mmHg are now classified as having elevated or stage 1 high blood pressure.


What’s behind the changes: Research shows that adults with blood pressure readings considered prehypertensive under the old guidelines have already doubled their risk of having a major cardiac event — a heart attack or a stroke — compared to those with a normal blood pressure. In addition, recent clinical trials find that lowering systolic blood pressure to 120 mmHg results in significant cardiovascular benefit in high-risk patients compared with blood pressure control to <140 mmHg.


New Categories


There are four blood pressure categories: normal; elevated; high blood pressure, stage 1; high blood pressure, stage 2.


Normal Elevated


Systolic BP mmHg Diastolic BP mmHg <120


and


Hypertension, Stage 1 130-139 or Hypertension, Stage 2 ≥140


120-129 and or


<80 <80


80-89 ≥90


Being Treated for Hypertension? The new guidelines lower the threshold for when treatment is needed. It’s a good time to revisit your treatment plan and decide whether your target blood pressure numbers should be lower than your current goals. You may need to increase your medications, lifestyle changes or both.


Drive Down Blood Pressure


Making healthy lifestyle changes is an important part of treatment for everyone, regardless of how high your blood pressure is and whether or not you are taking one or more blood pressure-lowering medications. Lifestyle changes can lead to big improvements in your blood pressure and risk for heart problems.


Having elevated or stage 1 high blood pressure is a red flag that you must make purposeful lifestyle changes. Although not always easy, lifestyle changes are proven to lower blood pressure, protect heart health and carry other health benefits. Lose weight. If you’re overweight, it’s important to try to get down to your recommended body weight. Have a heart-healthy diet, and lower your salt intake. One example is following the Dietary Approaches to Stop Hypertension (DASH) diet.


Boost your intake of potassium-rich foods. Good sources include bananas, avocados, spinach, sweet potatoes, wild-caught salmon, acorn squash and beans. Be physically active regularly. Most types of activity count. Examples include brisk walking, cycling, swimming, dancing, gardening and even housework. Avoid or limit alcohol. The recommendation is to limit alcoholic beverages to no more than two a day for men and one drink for women.


Who’s at Risk


If you have stage 1 high blood pressure, your risk of having heart disease or a stroke will help guide your treatment. Based on the new guidelines, gauging your risk for heart or vascular disease can help determine how best to manage your blood pressure — that is, whether lifestyle changes alone or lifestyle changes coupled with a cholesterol-lowering medication are recommended.


A heart attack or a stroke is usually caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries. Risk is determined using the ASCVD risk calculator, which helps to assess how likely you are to have a heart attack or stroke within the next ten years. The calculator takes into account your age, gender, total cholesterol and HDL (good) cholesterol, systolic blood pressure (the top number) and whether you smoke or have diabetes.


Using this ten-year risk estimate helps pinpoint who is likely to benefit most from blood pressure-lowering medications. If your risk of having a heart attack or stroke is ten percent


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