Blood pressure cuff

New guidelines mean more Americans are now living with high blood pressure

School of Nursing expert Cheryl Dennison Himmelfarb discusses what the changes mean for heart health and what people can do to lower their blood pressure.

Do you know your blood pressure? More importantly, do you know whether your blood pressure puts you at risk for heart attack, stroke, or other cardiovascular conditions?

If you haven't been to the doctor recently, your answers to those questions may have changed without you even realizing it. That's because new guidelines issued late last year altered the definition of hypertension, a move that is expected to result in roughly half of the U.S. adult population having high blood pressure. It's the first set of comprehensive guidelines to be issued since 2003, and the authors hope the new guidelines will help spur more adults to make lifestyle changes that improve their heart health.

"The intent is not to scare, but to activate people."
Cheryl Dennison Himmelfarb
Cardiovascular risk management expert

The guidelines, issued Nov. 13 by the American Heart Association and the American College of Cardiology, lowered the bar for what is considered hypertension from 140/90 to 130/80 millimeters of mercury. The first number—systolic blood pressure—describes the pressure on blood vessels when the heart contracts. The second number—diastolic blood pressure—measures the pressure in the vessels between heartbeats.

The guidelines are expected to affect people under 45 most dramatically. The number of men under 45 who are diagnosed with high blood pressure is expected to triple, and the number of women under 45 diagnosed is expected to double.

For more insights into these new guidelines, The Hub reached out to Cheryl Dennison Himmelfarb, a professor and associate dean for research at the Johns Hopkins University School of Nursing who is an expert in cardiovascular risk management and the social and cultural determinants of health. She was among the 21 scientists and health experts who authored the guidelines.

What do these new guidelines mean for the heart health of Americans?

Cheryl Dennison Himmelfarb

Image caption: Cheryl Dennison Himmelfarb

The intent is not to scare, but to activate people. The majority of people who are newly diagnosed with hypertension as a result of these new guidelines will be recommended to make lifestyle changes in order to reduce their blood pressure and their cardiovascular risk. It's only a small proportion of people who are already at the highest risk who will be recommended to take blood pressure-lowering medications in addition to making lifestyle modifications. Those individuals that have other risk factors or conditions—they've had a cardiovascular event like a heart attack in the past, or maybe they have diabetes, for example—they'll be recommended to get on blood pressure medications to more aggressively lower their blood pressure levels.

What are the risks associated with high blood pressure?

It's a really important message: Hypertension is a risk factor for heart attack, stroke, kidney disease, and many other prevalent conditions. There's also a growing body of evidence that lower blood pressure is better for health overall. That new evidence is really what's driving this lower target and lowered definition of hypertension.

Data show that the risk for heart attacks, strokes, and other consequences of high blood pressure actually begin to occur at any level above 120 systolic. In fact, risk doubles at 130 compared to 120. So that really emphasizes the benefit of driving blood pressures lower.

What are some of the lifestyle changes physicians recommend to lower blood pressure?

Lifestyle modifications are actually recommended for everyone who has elevated blood pressure above 120 systolic, because there can be incremental benefits in terms of improving overall cardiovascular health. The typical recommended lifestyle modifications include, primarily, weight loss among those who are overweight or obese; a heart-healthy diet that is low in sodium, high in potassium, low in saturated fats, and high in fiber; increased physical activity; and reducing alcohol consumption.

What else should we know about these new guidelines?

We see this as an opportunity to improve the cardiovascular health of our nation. Again, the message isn't to scare, but to activate everyone to ensure that members of our community are aware of their blood pressure values, their blood pressure goals, the cardiovascular risks, and what they can do to lower their blood pressure risk to live healthier longer.