Expanded guideline means more than 100 million people have high blood pressure.
The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg. This means that more than 100 million adults will now have high blood pressure, though many will be unaware of the diagnosis.
The 192 page guideline (the executive summary is only 112 pages) is the long-awaited update of the US hypertension guideline. The last “official” guideline was the NIH’s seventh Joint National Commission, which was published in 2003.
In 2013 the NIH announced that it would no longer be responsible for developing influential guidelines like the JNC guideline for hypertension and the Adult Treatment Panel (ATP) guideline for cholesterol.
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure was released today at the American Heart Association meeting in Anaheim and published simultaneously in Hypertension and the Journal of the American College of Cardiology.
The new guideline eliminates the category of prehypertension. The new blood pressure categories are:
- Normal:<120/80 mm Hg;
- Elevated:Systolic between 120-129 and diastolic less than 80;
- Stage 1: Systolic between 130-139 or diastolic between 80-89;
- Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
- Hypertensive crisis: Systolic >180 and/or diastolic >120.
The guideline authors said that the the impact of the new guideline will be greatest among younger people. They said the prevalence of hypertension in people under the age of 45 would triple among men and double among women.
At a news conference, Paul Whelton the chair of the writing committee, said that the new guideline contains 106 recommendations. The first hypertension guideline contained only 6 recommendations, “so we’ve come a long way,” he said.
In an accompanying paper published in Circulation, Paul Munter (University of Alabama at Birmingham) and colleagues used national survey data to estimate the impact of the new guideline.
The prevalence of hypertension will increase from 31.9% under JNC7 criteria to 45.6%. This works out to 103.3 million people who will be categorised as having high blood pressure.
In the new guideline antihypertensive drug therapy is recommended for 36.2% of US adults, or 81.9 million adults, while 21.4 million are recommended for nonpharmacologic therapy only. The new guideline increases the number of US adults recommended for drug therapy by 4.2 million.