A cardiologist explains why those new blood pressure guidelines are important

The American Heart Association estimates the change will mean 46 percent of adults in the U.S. will be identified as having high blood pressure.

Blood Pressure Guidelines
A doctor reads a blood pressure gauge during a patient examination. –Joe Raedle/Getty Images

Heart experts released new definitions Monday for what constitutes high blood pressure, opening the door for millions of Americans to be diagnosed with the condition.

Under the new guidelines, developed by the American Heart Association and American College of Cardiology, anyone with blood pressure of 120 over 80 is considered to have “elevated blood pressure” while any patient with a reading of more than 130 over 80 will be classified as having “Stage 1 High Blood Pressure.” High blood pressure was previously defined as 140 over 90 or higher.

The American Heart Association estimates the change will mean 46 percent of adults in the U.S. will be identified as having high blood pressure, compared to the 32 percent under the old definition.


“Yes, we will label more people hypertensive and give more medication, but we will save lives and money by preventing more strokes, cardiovascular events and kidney failure,” Kenneth Jamerson, a professor of internal medicine at the University of Michigan Health System who was involved in writing the guidelines said in a statement.

To learn more about the changes, which have been under development for three years, we spoke with Jorge Plutzky, director of Preventive Cardiology at Brigham and Womens’ Hospital. Below, he breaks down what impact he thinks the new guidelines will have on doctors and patients.

This interview has been edited for clarity and length.

Boston.com: What do these new guidelines mean?

Jorge Plutzky: They provide further emphasis on the importance of getting blood pressure down to less than 130 over 80, which is a step down from prior recommendations. It’s based on additional evidence that we’ve had of the benefit of getting one’s blood pressure down to a more optimal rage.

New Blood Pressure Guidelines
The new blood pressure guidelines from the American Heart Association. —American Heart Association

It’s important for individuals who hear this kind of news to recognize that there’s a lot of complexity involved and that guidelines are just a guide. It is always important to tailor to a specific situation. And the guidelines, when you get beyond the top line, go into a lot of detail about tailoring therapy as appropriate.


I think an important message embedded in these guidelines is that high blood pressure is very important and that it it does contribute to what’s the biggest cause of death and disability for Americans, which is heart disease, heart attack, and stroke. There is real value in taking on the work of getting one’s blood pressure down. Which involves not just doing better with lifestyle but can also mean being on medications.

By moving the target down for what’s considered high or elevated, are experts hoping that patients will take the risk of blood pressure more seriously?

Yes, I think that’s part of it. I think there’s a spectrum of what comes out of these guidelines and also their coverage. One aspect is drawing attention to the idea that blood pressure really matters, that it’s important to get it lower. There’s inevitably more emphasis on, ‘Well, why are these experts saying that?’ It’s based upon good evidence and good data that says there’s a real benefit to you if you do this — in terms of things that may arise later and in terms of how people do.

I think there’s another aspect that if it comes down to needing a drug — hard doses of a drug that one’s taking or additional drugs — there’s a reason to do that.

Finally medicine is so complex and challenging, that guidelines like this are also very helpful in laying out and summarizing the data for busy clinicians.


Just in terms of sheer numbers, even though heart disease is incredibly common, there’s a lot more people out there who might be in their 40s, 50s, 60s, and not have any problem and who are not necessarily getting treated appropriately. So you can have a big impact, through guidelines, on both patients and doctors by saying, ‘Hey, don’t keep kicking the can down the road, this patient should be treated.’

What do you think the benefit will be of these guidelines?

I think the immediate benefit is that it will bring these issues to the attention of patients and doctors and provide a clear basis and rationale for approaching these issues, including the more complex patients.

People don’t really realize that when someone has a heart attack or a stroke, it can seem like a very sudden event.  Patients or families will really say, ‘Well this really came out of the blue.’ But heart disease is often a process that begins quite early and progresses for a very long time in a silent mode. So when a heart attack happens, and let’s say in a given patient it’s been driven along because of high blood pressure potentially along with some other issues, that disease process has now worked for a very long time and is now just suddenly raising its head.

Is there any downside or concern the guidelines will cause any kind of adverse impact?

Guidelines guide. Every patient is different. There are certainly some situations in which one has to be careful and not just assume one size fits all and we’ve got to get your blood pressure down. There can be patients in which that can cause issues for them. For most people it won’t and you just have to monitor it.

But there’s always a need for good judgement.

There’s always the possibility that the guidelines will upset people because they get fixated on a specific number and they get very frustrated when they can’t get to that number. But still they may be so much better off by going from 180 to 140. And then if they can’t get to 130 despite their best efforts — that’s still better.

What these guidelines are emphasizing is there’s so much benefit from a better blood pressure number and paying attention to blood pressure and not ignoring it, even if you’ve never had a complication of heart disease. Doing that greatly offsets concerns about risk. We are talking about something that’s incredibly common – both blood pressure and heart disease really can’t be ignored. And the impact of improving blood pressure is very impressive in terms of how you can lower risk.

If your blood pressure is 20 points above where it should be, in terms of the first number, the systolic, and ten points higher on the diastolic, that can mean you’ve doubled your risk of dying from stroke or heart disease. So, I mean, that’s big.

You mentioned the age group of people in their 40s, 50s, 60s. Is that the group that’s going to be most impacted by this change?

Potentially. I mean if you just talk about sheer numbers, yes, because there’s so many of those people. But I think there’s also the possibility of patients who are already being followed, who might have already had heart attacks whose blood pressure has been in a more borderline area, even with the medicines. It may be that the doctor is now going to feel more emboldened to say, ‘You know we really should do something about this.’

In terms of who is going to benefit the most — in terms of numbers it will be those people who’ve not had a problem and now have a message coming at them that ‘This could really help you, don’t run away from it.’