NEW BLOOD PRESSURE RECOMMENDATIONS:
JUST WHAT WE HAVE BEEN SAYING ALL ALONG
(March 2004)

The new guidelines released in May 2003 add an additional category called pre-hypertension. That is defined by a systolic blood pressure of 120 to 139 millimeters of mercury and/or a diastolic pressure of 80 to 89 millimeters of mercury. That change reflects the persuasive evidence that the effects of increasing blood pressure are on a continuum, and the more either the systolic or diastolic pressures are increased above optimal, the greater the risk of heart attack or stroke. In this report, the authors state that a 20 millimeter increase in systolic pressure (for example, from 120 systolic to 140 systolic) or a 10 millimeter increase in diastolic pressure (for example, from 80 millimeters to 90 millimeters of mercury) will double the risk of heart attack and stroke.

Healthful Life, using the same evidence, divides blood pressure into five categories:

- Ideal is the blood pressure at or below which there are no health consequences - no increase at all in heart attacks, strokes, congestive heart failure, or kidney failure. Nobody knows exactly what blood pressure level is ideal. Healthful Life has arbitrarily listed that level for adults as at or below 110 millimeters systolic, 70 millimeters diastolic. The expert committee seems to use 115 systolic, 75 diastolic.

- Optimal is less than 120 systolic, 80 diastolic. That is a reasonably healthy level.

- Normal is 120 to 129 systolic, 80 to 84 diastolic.

- High-Normal is 130 to 139 systolic, 85 to 89 diastolic. At this level, there is a modest increase in risk of heart attack and stroke.

- Hypertension is 140 and above systolic, 90 and above diastolic. At this level, the risk of heart attack and stroke is very substantial.

The expert group calls less than 120 systolic, less than 80 diastolic normal (rather than our designation of optimal), and they call 120 to 139 systolic, 80 to 89 diastolic pre-hypertension; we list such blood pressure as normal (120 to 129, 80 to 84) or high normal (130 to 139, 85 to 89).

The expert group and Healthful Life agree that any adult with blood pressure of 120 to 139 systolic, 80 to 89 diastolic should try to reduce that blood pressure to get it below 120/80. Healthful Life offers a bit more flexibility. If your blood pressure is high normal (130 to 139 systolic, 85 to 89 diastolic), at least get it into the next lower category (120 to 129 systolic, 80 to 84 diastolic); if possible, get it into the optimal category. If your blood pressure is 120 to 129 systolic, 80 to 84 diastolic, try to get it into the optimal range (less than 120/80).

The expert group and Healthful Life agree that, for pre-hypertension (our normal, high normal categories), the approach is lifestyle and dietary change, NOT medications. We worry that the designation pre-hypertension will label people and will result in doctors prescribing (and patients demanding) medications. That is not a good idea. It is also likely the over-the-counter alterative and complementary medicine entrepreneurs will have a field day with poorly documented products for those labeled as pre-hypertensives. Remember that all medications can have some adverse effects.
Keeping the blood pressure in a desirable range is a major component of health promotion.

There are multiple non-drug approaches to getting into the normal range if you have high normal blood pressure or into the optimal range if you have normal blood pressure. These include:

- taking off some weight; five or ten pounds can often make a huge difference

- increasing your physical activities (if you are over age 40 or if you have or think you might have an underlying condition that might be harmed by increased physical activity, check with your health care provider)

- go on a high vegetable, high fruit, high low-fat dairy food diet (also high in poultry, fish, nuts)

- if necessary, reduce salt intake

(See Archives "Fruits, vegetables, dairy foods, salt and high blood pressure - your diet can make a difference"; and "Diet with or without salt restriction can keep your blood pressure lower or can treat mild hypertension"; see also The Changing Approach to Evaluating Blood Pressure in the Archives under Blood Pressure).

Note that, in determining which category you are in (ideal, optimal, normal, high normal, hypertension), you need multiple readings when seated quietly. The category is determined by the highest value of either the systolic or diastolic pressure. For example, 120/86 is high normal because of the diastolic value of 86; 134/80 is high normal because of the systolic value of 134.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Journal of the American Medical Association. Vol 289 (May 21) Pgs 2560-2572. 2003.