2017 hypertension guideline makes the threshold tighter

As per the new hypertension guidelines of 2017 a blood pressure (BP) reading of 130/80 mm Hg or higher is being regarded as the new high as per the latest guidelines released in this regard by AHA/ACC (American Heart Association/American College of Cardiology). This is far tighter than the measurement provided by the Joint National Committee 7th Report (JNC 7) that had laid down the marker at 140/90 mm Hg. JNC 7 had stated that this could be regarded as stage 1 hypertension among the general people of the world. This change means that now a greater number of people would be considered to be under the threat of hypertension.

The chairman of the writing committee, Dr. Paul K Whelton, who is from the Tulane University School of Public Health and Tropical Medicine and School of Medicine at New Orleans, Louisiana, the United States of America (USA), has stated that these are practical decisions. He has also pointed out that the last time the classification was changed was back in 1993. The body has moved the bar down because it has unearthed conclusive proof that at stage 1 people have 200 percent the greater risk of suffering a stroke or a heart attack.

Dr. Whelton has stated that people should know this so that they are able to make the necessary changes to their lifestyles. He has further stated that available evidence – from drug trials as well as nondrug ones – has proven that keeping the BP levels below this mark would inevitably prove to be beneficial for one and all. The normal BP still remains at <80 diastolic and <120 systolic. Dr. Whelton says that if the BP is around <80 and 120-129 mm Hg there is enough reason to be concerned. It is high BP and signals that the concerned person should be worried.

What is the best way to measure BP?

The guidelines have made it very clear that in order to categorize BP levels properly clinicians should measure BP accurately in both the arms of the patient. They should use the arm, which provides the higher BP in order to get an average of >2 readings for >2 occasions. They also recommend that people get their BPs measured outside of their office. Whelton has stated that while the BP reading that people get in the office helps them it still happens to provide a rather small window.

There are certain people who suffer from masked hypertension. This means that their BP readings are normal when measured at the clinic but high when measured at home. These people need to know that their risk pattern could be similar to ones who suffer from consistent hypertension. On the other hand, there are some people who suffer from white coat hypertension. This means that their BP is normal outside their office, where it tends to be on the higher side. For this people, the risk pattern is a lot similar to those suffering from normotensive hypertension. This is the reason why BP readings need to be taken in various areas so that a proper figure could be arrived at and proper treatment could be administered.

BP targets for special people

The committee has fixed a level of 130/80 mm Hg for adults who are confirmed to be suffering from hypertension and other known cardiovascular diseases (CVDs). This is also applicable for people with the chance to suffer an atherosclerotic event in the next 10 years as well as ones who have a chance of more than 10 percent of suffering from such diseases. In case of people who are suffering from hypertension but do not have the additional CVD risk, this particular target could be considered a reasonable one.

Dr. Whelton has further stated that in case of older adults who are suffering from high BP it has been seen in a number of trials that lowering their BP can be really helpful. The best part of this is that it can be done in an effective manner without the risk of issues such as hypotension, fractures, and falls. He has made it quite clear that people who are 65 years and older, and ones who are at risk from a cardiovascular point to get drug therapy.

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