In 2003, new blood pressure guidelines gave us a wake up call. The National High Blood Pressure Education Program released stricter rules. Their goal was to increase public awareness of hypertension prevention and treatment. A new blood pressure section called prehypertension was added. Blood pressure levels that had been called normal now became prehypertensive.
Hypertension, or high blood pressure, is diagnosed when a blood pressure reading of 140/90 mmHg or greater is noted. The level must be seen on at least two readings to be officially diagnosed. The upper number is the systolic pressure when your heart contracts. The lower number is the diastolic pressure when your heart relaxes.
If your blood pressure was 139/89 mmHg or below, it was considered normal. With 2003 guidelines, only a reading below 120/80 mmHg is considered normal. When your blood pressure is slightly higher than this, you have prehypertension.
Here is a summary of the new classification system. Recommended therapy is listed for each level of blood pressure.
| Category | Systolic blood pressure (mm Hg) | Diastolic blood pressure (mm Hg) | Lifestyle changes advised | Drugs usually recommended |
|---|
| Normal | Less than 120 | Less than 80 | Encouraged | No |
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| Prehypertension | 120-139 | 80-89 | Yes | No |
|---|
| Stage 1 hypertension | 140-159 | 90-99 | Yes | Yes |
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| Stage 2 hypertension | 160 or more | 100 or more | Yes | Yes |
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Modified from Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure.
JAMA.
2003;289:2560-2572.
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Prehypertensive patients are more likely to develop full-blown hypertension. They are also more likely to develop associated health problems. Heart disease,
stroke,
kidney disease, blindness, and
Alzheimer’s disease are all associated with hypertension.
Studies indicate cardiovascular risk increases as blood pressure rises above 115/75 mmHg. In fact, your risk doubles with every 20 mmHg rise in systolic pressure or with every 10 mmHg rise in diastolic pressure.
According to the National High Blood Pressure Education Program, everyone should have a blood pressure check at least once every two years. If your blood pressure is above normal (that is, higher than 120/80 mmHg), your doctor may recommend that you have it rechecked more often. People at increased risk for hypertension may also need more frequent readings. Risk factors include a family history of the condition, African American race, above-normal weight, or age greater than 50.
Unlike hypertension, prehypertension treatment does not usually include drugs. The mainstay of therapy for prehypertension is lifestyle changes. These changes can help to slow or prevent progression to hypertension. The National High Blood Pressure Education Program recommends:
- Lose excess weight. Studies show that each 10 pounds of weight loss is associated with an average drop in systolic blood pressure of up to about 10 millimeters of mercury.
- Increase physical activity to at least 30 minutes most days of the week. First get your doctor’s approval if you’re not accustomed to exercise.
- Eat a healthful diet. Daily food intake should be low in saturated fat and cholesterol and rich in whole grains, fruit and vegetables, and lowfat dairy foods.
- Reduce salt intake to no more than 2.4 grams (g) of sodium (the equivalent of about a teaspoon of table salt) a day.
- Limit alcohol use. This meaning no more than two drinks a day for men or one for women.
“The majority of cases of hypertension can be prevented and controlled,” writes Thomas Kottke, MD, of the Mayo Clinic in an editorial that accompanies the guidelines. But he notes that Americans, are failing to make the grade. Despite scientific advances, government surveys show that public awareness of high blood pressure has not improved over the past 10 years. Only about one-third of patients with hypertension receive adequate treatment today.
In hopes of improving the situation, the National High Blood Pressure Education Program released the new guidelines to emphasize the need for more aggressive prevention, detection, and treatment. Presently, over 50 million people in this country have high blood pressure and an estimated 45 million more have prehypertension. If we don’t take action now, 90% of us will likely develop high blood pressure during our lives. In order to stave off a looming epidemic of hypertension, prevention is urgently needed.
