New guidelines lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition, which now plagues nearly half of U.S. adults.
High
pressure, which for decades has been a top reading of at least 140 or a
bottom one of 90, drops to 130 over 80 in advice announced Monday by a
dozen medical groups.
The guidelines, announced at an American
Heart Association conference in Anaheim, mean an additional 14 percent
of U.S. adults have the problem.
It's recommended that people with
high blood pressure try healthier lifestyles, which get much stronger
emphasis in the new advice. Poor diets, lack of exercise and other bad
habits cause 90 percent of high blood pressure.
"I have no doubt
there will be controversy. I'm sure there will be people saying, 'We
have a hard enough time getting to 140,'" said Dr. Paul Whelton, a
Tulane University physician who led the guidelines panel.
But the risk for heart disease,
stroke and
other problems drops as blood pressure improves, and the new advice "is
more honest" about how many people have a problem, Whelton told CBS
News chief medical correspondent Dr. Jon LaPook.
The upper
threshold for high blood pressure has been 140 since 1993, but a major
study two years ago found heart risks were much lower in people who
aimed for 120. Canada and Australia lowered their cutoff to that; Europe
is still at 140 but is due to revise its guidance next year.
Currently,
only half of Americans with high blood pressure have it under control.
Dr. Whelton said the additional patients now classified as having
hypertension should be able to manage their condition with diet and
lifestyle changes alone.
"Most of them just need to know they're at high risk, but they can manage that problem on their own," Whelton told LaPook.
At
a health fair in New York City Monday, Adrienne Williams suddenly found
herself with a new diagnosis of hypertension, her blood pressure in the
130s.
"Hypertension is considered a silent killer and now it's
something I need to research, and I wouldn't have known that had I not
stopped through today," Williams said.
What the changes mean
The guidelines set new categories and get rid of "prehypertension":
- Normal: Under 120 over 80
- Elevated: Top number 120-129 and bottom less than 80
- Stage 1: Top of 130-139 or bottom of 80-89
- Stage 2: Top at least 140 or bottom at least 90
That means 46 percent of U.S. adults have high pressure (stages 1 or 2) versus 32 percent under the old levels.
How common it is will roughly triple in men under 45, to 30 percent, and double in women of that age, to 19 percent.
For
people over 65, the guidelines undo a controversial tweak made three
years ago to relax standards and not start medicines unless the top
number was over 150. Now, everyone that old should be treated if the top
number is over 130 unless they're too frail or have conditions that
make it unwise.
"The evidence with this is so solid, so
convincing, that it's hard to argue with the targets," said Dr. Jackson
Wright, a guidelines panel member from University Hospitals Cleveland
Medical Center. Older people "have a 35-to-50-fold higher risk of dying
of a
heart attack or stroke compared to younger people."
But the Cleveland Clinic's Dr. Steven Nissen said he's worried.
"Some
more vulnerable patients who get treated very aggressively may have
trouble with falls" because too-low pressure can make them faint, he
said.
Who needs treatment
Certain groups,
such as those with diabetes, should be treated if their top number is
over 130, the guidelines say. For the rest, whether to start medication
will no longer be based just on the blood pressure numbers. The decision
also should consider the overall risk of having a heart problem or
stroke in the next 10 years, including factors such as age, gender and
cholesterol, using a simple formula to estimate those odds.
Those
without a high risk will be advised to improve their lifestyles -- lose
weight, eat healthy, exercise more, limit alcohol, avoid smoking.
"It's
not just throwing meds at something," said one primary care doctor who
praised the new approach, the Mayo Clinic's Dr. Robert Stroebel. If
people continue bad habits, "They can kind of eat and blow through the
medicines," he said.
The guidelines warn about some popular
approaches, though. There's not enough proof that consuming garlic, dark
chocolate, tea or coffee helps, or that
yoga, meditation or other behavior therapies lower blood pressure long-term, they say.
The
government no longer writes heart guidelines, leaving it to medical
groups. Unlike previous guideline panels, none on this one have recent
financial ties to industry, although some on a panel that reviewed and
commented on them do.
The guidelines were published in two journals -- Hypertension and the Journal of the American College of Cardiology.
How and when to check it
Blood
pressure should be checked at least once a year by a health
professional, and diagnosing high pressure requires 2 or 3 readings on
at least two occasions.
The common way uses a cuff on the upper
arm to temporarily block the flow of blood in an artery in the arm and
gradually release it while listening with a stethoscope and counting
sounds the blood makes as it flows through the artery. But that is prone
to error, and many places now use automated devices.
The
guidelines don't pick a method, but recommend measuring pressure in the
upper arm; devices that work on fingers or are worn on wrists "aren't
ready for prime time," Whelton said.
Home monitoring also is recommended; devices cost as little as $40 to $60.
What about kids?
Unlike adults, numbers for normal
pressure in children
vary with age, height and gender. Kids should be checked at least once a
year for high pressure, say guidelines announced in August by the
American Academy of Pediatrics.
After age 13, the levels defining
high pressure are the same as for adults, said a member of the
pediatrics panel, Dr. Elaine Urbina of Cincinnati Children's Hospital
Medical Center.
"When you turn 18 years and one minute, you shouldn't suddenly have a new definition," she said.
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