The American Heart Association, the American College of Cardiology and nine other heart health groups now agree that you have high blood pressure if your blood pressure is above 130/80, not 140/90 as the previous guidelines recommended (American Heart Association’s annual meeting, November 13, 2017).
This means that 46 percent of North American adults now have high blood pressure, which means that they are at increased risk for heart attacks, strokes, diabetes and premature death. The new guidelines will triple the number of men under 45 years of age with high blood pressure, and double the number of women under 45 with high blood pressure. Another 40 percent of the population will develop high blood pressure as they grow older.
The blockbuster SPRINT study of almost 10,000 people showed that blood pressures above 130 increase risk for death (N Engl J Med, Nov 26, 2015;373:2103-2116). High blood pressure causes heart attacks, strokes and kidney disease and puts you at increased risk for developing dementia in later life. High blood pressure is intimately associated with high blood sugar levels after meals, and high blood pressure is one of the criteria for diagnosing diabetes.
Lowering Blood Pressure without Drugs
The majority of people with blood pressures between 120 and 140 have the potential to lower their high blood pressures without taking drugs. If they are sufficiently motivated, they can get their blood pressures to normal with lifestyle changes:
- getting rid of their excess belly fat
- losing excess weight (Losing just 10 pounds can reduce systolic high blood pressure by 5 mm of mercury.)
- exercising daily and growing larger muscles
- avoiding alcohol and smoke
- eating a high-plant diet with lots of vegetables, fruits, whole grains, beans, nuts and other seeds
- limiting or avoiding sugar-added foods and drinks, meat from mammals, processed meats and fried foods
- limiting salt intake
- drinking only water, coffee or tea, with nothing added to them
- keeping blood levels of hydroxy vitamin D above 30 ng/mL
Most people who cannot get their systolic blood pressures below 130 with these lifestyle changes will probably be advised to take drugs.
Checking Your Own Blood Pressure
Never let your doctor use a single blood pressure measurement to diagnose high blood pressure. Your blood pressure can rise just because you are in the doctor’s office. It can also rise when you eat, exercise or move around, or when you are startled or afraid.
I recommend that everyone should have their own arm blood pressure cuff (wrist cuffs are not very dependable). They are inexpensive and are available at any pharmacy. Every night for at least a week, take your blood pressure when you are ready to go to bed and have been resting for 10-15 minutes. That is when your blood pressure is usually lowest. Keep a record of the readings and take the average after a week. If your systolic blood pressure averages greater than 120, you have high blood pressure and need serious lifestyle changes immediately. Check with your doctor.
Who Should Take Drugs for High Blood Pressure?
People who have high blood pressure plus two or more of the heart attack risk factors listed below will probably be advised to take blood-pressure-lowering drugs. Your doctor can examine you and order all of these tests:
- LDL (bad) cholesterol>100
- HBA1C>5.7 (diabetes)
- CRP>1 (inflammation)
- Abdominal obesity
- Small hips
- Resting heart rate >70
- Lp(a)>125 (blood test for a genetic disorder)
- Triglycerides >150 (primarily from dietary sugar)
- HDL (good) cholesterol<40
- Homocysteine>10 (genetic or vitamin deficiency)
- Small LDL particle size (an indicator of diabetes)
- Family history of heart attacks
Gabe Mirkin, M.D., is a sports medicine doctor and fitness guru. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin has run more than 40 marathons and is now a serious tandem bike rider with his wife, Diana. His website is http://drmirkin.com/. Click to read Gabe’s full bio.
Rick Edgar says
I’m hearing that your age plus 100 is the new guide line. What is your take on this?
Randall S. Stafford, MD, PhD says
Excellent recommendations. One of the best quick summaries I’ve seen. I would add obtaining adequate, high quality sleep to the list of strategies. A few of the risk factors listed (e.g., heart rate > 70) don’t have strong evidence of independent risk status (i.e., separate from the other risk factors listed), but are nonetheless logical extensions from current knowledge. For more advice, check-out: http://scopeblog.stanford.edu/category/too-high/
Charlie Johnson says
I believe there are typos in the above guidelines for LDL and HDL. It should be LDL<100, and HDL>40.
G Moore says
“Keep a record of the readings and take the average after a week. If your systolic blood pressure averages greater than 120, you have high blood pressure…” Shouldn’t this value be 130?
Kerry Irons says
Those numbers are in the list of “people with these numbers should consider controlling blood pressure”
Kerry Irons says
I wondered the same thing, but the method he describes for taking BP (very relaxed) is not accessible to clinicians, so perhaps the “extra 10 mm” is to account for the fact that clinical BP checks are virtually certain to be higher than a number you collect just before you go to bed.
John Tonetti says
With all due respect, you said “This means that 46 percent of North American adults now have high blood pressure, which means that they are at increased risk for heart attacks, strokes, diabetes and premature death.”
Sorry, Dr. Mirkin, but I call “bullshit”. Those who fell between 130/80 and 140/90 have no more increased risk than they had before. Their risk is EXACTLY the same. What’s changed is that more physicians can prescribe more BP meds… enriching themselves, and big pharma.
Statements such as these are misleading, inaccurate, and damage the credibility of health care professionals. I’m surprised at you.
I also have a question abou the bedtime 120 number. Is this a typo? If not, I don’t understand the logic.