New battle lines have just been drawn in the decades-old public health fight against the leading cause of death and disability in the United States: heart disease.
This month, the American Heart Association and its partner organizations issued a new set of guidelines for the diagnosis and management of hypertension, also known as high blood pressure.
I urge adult readers to pay close attention to the most significant change. The definition of high blood pressure has been lowered to 130/80! Under this new definition, more than half of adults in the U.S. have hypertension, a disease closely linked to cardiovascular conditions such as coronary heart disease, stroke and peripheral vascular disease.
Why the change?
Among heart disease risk factors, hypertension is the most common and second only to tobacco smoking in terms of magnitude of risk. Even under the old definition of hypertension, which was blood pressure above 140/90, the AHA had already indicated that adequate control of blood pressure alone could save 1 million lives in 10 years in the U.S. Now the stakes are higher.
It has long been known that risk of cardiovascular disease rises with the level of blood pressure. Since the 1970s, the blood pressure above which the greatest risk accumulated was felt to be 140/90. However, for many years now, professional medical organizations have been advocating for lower targets based on the observation that those with lower blood pressure fare better.
Now the strength of the evidence is sufficient enough that medical experts generally agree about the need to actively target the lower number of 130/80.
To put this in perspective, it is estimated that more than 700,000 people in the United States suffer a heart attack each year. Nearly 1 in 4 American deaths each year is attributable to heart disease, most commonly as a result of coronary heart disease, for which hypertension is the most common and second most severe risk factor, after smoking.
More than 75 million Americans suffer from hypertension under the old definition of 140/90. Only half of these people have their blood pressure under control. Under the new definition of high blood pressure (over 130/80), half of American adults meet the definition for hypertension.
For those in the new “Stage 1” group with blood pressure higher than 130/80, this means active lifestyle efforts to target a lower blood pressure and medication therapy among those whose risk is significant. For those in the new “Stage 2” group with blood pressure higher than140/90 and beyond, it means more aggressive efforts at lowering blood pressure through lifestyle changes and a combination of medications.
Lifestyle measures include a low sodium diet with emphasis on vegetables, whole grains and fruits; regular physical activity; weight management; and smoking cessation. Reduced alcohol intake and treatment of sleep disorders are also important.
The guideline recommends annual blood pressure testing for all adults and more frequently for those with elevated blood pressure.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.