How Will The New Blood Pressure Guidelines Effect You?

Concerned senior couple in the hospital
Concerned senior couple in the hospital
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Written by Eli Ben-Yehuda

On December 5, 2023

How The New guidelines May Affect You

New blood pressure guidelines, implemented November 16th 2021, lowered 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 blood 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.

“This means anyone with blood pressure higher than 130/80 will be considered to have hypertension or high blood pressure,” the American Heart Association and American College of Cardiology said in releasing their new joint guidelines.

The change means an additional 14 percent of U.S. adults have the problem, but only 2 percent of these newly added people need medication right away. The rest should try healthier lifestyles, which get much stronger emphasis in the new advice.

Are The New Guidelines Controversial?

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, he said.

Currently, only half of Americans with high blood pressure have it under control.

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.

The guidelines were announced at an American Heart Association conference in Anaheim.

What do the changes mean?

The guidelines, as follows, set new categories and get rid of “prehypertension.”

  • Normal: Under 120 over 80.
  • Elevated: Top number 120-129 and the bottom number 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) vs. 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 healthier, exercise more, limit alcohol, and 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 behavioral 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.


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Watch how Julie Lowered her Blood Pressure Naturally. It was 170/110, this morning it was 120/80 Watch Video

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.The American Heart Association and the American College of Cardiology are redefining high blood pressure. The change means almost half the US qualifies for the condition, the leading cause of heart disease.


Instead of recommending drug treatment right away, the organizations recommend that people with stage 1 hypertension try lifestyle changes first: exercising more, eating less salt, and eating more fruit, vegetables and whole grains.

“Lifestyle modification is the cornerstone for treatment of hypertension,” said Dr. Robert Carey of the University of Virginia, who helped write the guidelines. Other research, including a new study released just this week, shows the American Heart Association’s DASH diet lowers blood pressure and reduces people’s risk of stroke and heart failure.

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9 Replies to “How Will The New Blood Pressure Guidelines Effect You?”

  1. Scary. I think it is only natural that people over 60 have an increased risk of heart attacks and strokes, after all, they are in the last third of their life and, ultimately, will die. These are the cruel facts of life; The older one gets the higher the risk of dying, with or without drugs. I often wonder what old people die of, especially if they are on medication that should reduce the risk of dying.
    My questions are:
    1 How many people in 100 and over 60 years old in the control group survived the drug trial?
    2 How many people in 100 and over 60 years old in the treated group survived the drug trial?
    3 What was the duration of the drug trial?
    4 How many men and women in 100 and over 60 were included?
    5 Were some people over 60 excluded and why?
    6 What did those in the control group, who survived the drug trial, have in common and did not have a stroke or heart attack during the trial?
    7 Who were the sponsors of the drug trials?
    8 Has the aggressive treatment of blood pressure increased the rate of diabetes, high cholesterol, kidney problems, etc.
    9 How many people need to be treated to prevent a single heart attack or stroke? (= how much was the collateral damage caused by unnecessary treatment?)
    10 To what extent does blood chemistry change due to blood pressure medication? (The reason I am asking is because I was on medication and, prior to treatment, my cholesterol levels, triglycerides, blood sugar, were excellent. One year after treatment, all had risen to borderline needing treatment. Hooray, more drugs! The accumulation of side effects impacted on my enjoyment of life to such an extent that I decided to reduce the medication myself and discontinue it all together so desperate was I. UNDER NO CIRCUMSTANCES would I recommend to others to do this!!!
    11 Not a single physician has ever taken my blood pressure measurements according to the recommendations of the British Hypertension Society.
    Two younger friends of mine, in their early sixties, with normal blood pressure had heart attacks. ‘Normal’ actually was <120/80 and they were very surprised when they had a heart attack. One of them was a very fit man and a fellow hiker. They survived and are now on medication. Another one, on Beta Blockers, had an accident. She had a dizzy spell and slammed into a car. Thankfully, no one was seriously hurt, ‘only’ whiplash and aches and pains for quite a while. The doctor told her she will have to lower the dosage of her blood pressure medication. Two older friends in their mid seventies, on BP medication also had heart attacks. I am really confused.
    The new guidelines are scary, especially for people like I whose blood chemistry couldn’t be more perfect but, alas, have high blood pressure. Unfortunately, I know the feeling of coming off medication. It felt like recovering from the biggest hangover. Blood pressure medication can cause unpredictable dizziness in older people and many of these people are climbing stairs and driving every day. The risk of heart attacks and strokes may be reduced. Kudos to drugs. But, the risk of falls, car accidents and, despite medication, heart attacks and strokes, remains.
    30 million more people on medication! Wow! Buy shares in pharmaceuticals and use the dividends to buy medication. In more than sixty years of high blood pressure treatment the only treatment that is available is more drugs and the inclusion of more and more potential patients that can be treated. Is this good medicine or is this good business?
    I am using RESPERATE most days and have no idea whether or not it works. Measuring blood pressure freaks me out, but it is nice to just sit still and relax for 15 minutes in a busy day.

    1. I just wanted to thank you for your post and I do am terrified to take my BP.
      I agree with every word you wrote.
      God bless you

    2. You are absolutely correct that few doctor’s offices IF ANY actually ever take blood pressure readings properly. At home and relaxed your readings are normal 120/80 or below. Now, at the appointments you jump into the office, sit down and immediately get the cuff. The button gets pushed with your arm dangling by your side like a broken marionette’s appendage while a temperature probe is jammed in your mouth. All the while you’re peppered with the thousand question quiz of age, weight, height, color of your dog’s hair, etc. You’re shifting even more uncomfortably in the chair when they get to the question about ever telling a fish tale to your friends about the size of that …well…fish, that you claimed to have landed. The cuff deflates and your reading is now near 145 since you hadn’t the opportunity yet to even catch your breath from the quick nonstop flurry of questions and activity. The tech asks if you’ve had high BP and you innocently say “no”. They may even take a second reading literally 10 seconds later to see if it’s decreased -REALLY??? Do our bodies have an on/off switch that works that fast? However, medication is ultimately prescribed and you think, should I even take this knowing the office procedure for reading this has all been done wrong and results greatly misleading. One would think that if anywhere, the doctor’s office is where they would want/demand the most accurate reading for a proper baseline, but alas, too many patients and a harried staff serves no patient/customer well. It’s like taking your car to a bad mechanic who, in a rush, doesn’t diagnose your engine problem correctly and wants to repair a problem that may not exist. What to do…

  2. Big pharma is behind this. It’s all about the benjamins. Don’t piss down my back and tell me it’s raining.

    1. So true! How many more people (young) will now be placed on HBP meds. All to make more money!!

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