New American Guidelines Indicate A Drop In High Blood Pressure Threshold

In November 2017, the American College of Cardiology and the American Heart Association published new guidelines for the treatment of high blood pressure (hypertension). This directive broadens the definition of hypertension and recommends that it should be treated more quickly.

The result of these new guidelines, this equates to a requirement to treat almost half of the adult population in America for high blood pressure. Which at present is significantly higher than the UK’s statistics of one in three adults in the UK having high blood pressure. In England, 31% of men and 26% of women have high blood pressure[1].

However, perhaps the expansion in the classification of high blood pressure could relate to the fact that half of people with high blood pressure in the UK are not diagnosed or receiving treatment[2]. In England alone, there are more than five million people that are undiagnosed[3].


New guidelines

[1] Expansion of the definition of hypertension.

In the revised guidelines, hypertension is defined as blood pressure values = 130 mmHg systolic over 80 mmHg diastolic. Whereas at present the figures are at 140/90 (or 14/9)

It is emphasised that these figures must be the average of at least two measurements on at least two occasions. More emphasis is also placed on home blood pressure measurement, in order to prevent, among other things, white-coat hypertension and blocked hypertension.


[2] Treat with medication more quickly.

Immediately starting a drug treatment (in addition to adjusting the individual’s lifestyle) is recommended:

  • From 130 mmHg systolic over 80 mmHg diastolic in patients with strongly increased cardiovascular risk, i.e. suffering cardiovascular disease or an estimated 10-year cardiovascular risk of 10 percent or more according to the ASCVD risk score.

Up to now, this was from 140/90 mmHg. Diabetics and patients with chronic kidney disease are always counted among patients with a strongly increased cardiovascular risk.

  • From 140 mmHg systolic over 90 mmHg diastolic in patients with low cardiovascular risk, i.e. without existing cardiovascular disease and with a 10-year cardiovascular risk of less than 10 percent. Until now, only lifestyle adjustments were recommended in this group.

These recommendations apply to all ages.

[3] Lower treatment target values.

As target values, <130 mmHg systolic over <80 mmHg diastolic are recommended. This certainly applies to patients with a strongly increased cardiovascular risk, but also to patients with a low cardiovascular risk. Up to now, target values of <140/90 mmHg have been proposed.


Should we follow these guidelines?

In a commentary on these new American guidelines, the Belgian Center for Pharmacotherapeutic Information (BCFI) argues against the extension of the current European standards for treatment of hypertension in line with the American figures.

In particular, there are insufficient scientific arguments to justify the increase in the number of patients that should be treated according to these new criteria.

  • According to the American Academy of Family Physicians, 46 percent of the adult population in the US would be eligible for medical treatment, compared with 32 percent at present. Furthermore, the aim for lower blood pressure values would require more intensive treatment in many patients.
  • The possible health benefits of this treatment must be weighed against the impact of further medicalisation, against the risk of undesirable effects caused by medication and against the financial aspects.

European Guidelines

The existing European guidelines for the treatment of hypertension (which may be revised in 2018) are as follows:

  • The definition of hypertension is an upper pressure of 140 mmHg or higher and/or an underpressure of 90 mmHg or higher.
  • In the treatment of patients with hypertension, both low-risk patients and high-risk patients (including diabetics and patients with chronic kidney disease), the target value for systolic blood pressure is <140 mmHg.

The target value is slightly higher for people over 80: systolic blood pressure 140 to 150 mmHg; for vulnerable elderly, the target values should be determined individually, depending on the tolerance of the patient.

  • For diastolic blood pressure, the target value is <90 mmHg, except for people with diabetes whose target value is <85 mmHg.
  • Furthermore, patients with hypertension are advised to measure their blood pressure at home because this gives a more correct picture. For about 30 percent of patients, high blood pressure readings are measured when they subsequently visit the doctor – partly because they are not at ease – whereas having a healthy blood pressure rating at home.

It is recommended, therefore, to discuss with your general practitioner the desirability of home measurement, and to purchase a device with advice from the general practitioner and pharmacist.

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[1] Health Survey for England 2015

[2] British Heart Foundation, Cardiovascular Disease Statistics Factsheet UK, 21 June 2017

[3] Public Health England, Health matters: combating high blood pressure, January 2017

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