New guidelines mean you might have high blood pressure

Nearly half of U.S. adults now have high blood pressure, according to new guidelines from the American Heart Association and the American College of Cardiology. Here’s what’s changed.

What’s New

Experts now say that nearly one out of two—rather than one out of three—adults have high blood pressure, or hypertension. Why?

Doctors used to diagnose hypertension if your blood pressure was above 140 systolic (the higher number) or above 90 diastolic (the lower number). But that doesn’t capture everyone at risk.

“People in the 130-to-139 systolic or 80-to-89 diastolic range are at double the risk for a heart attack or stroke compared to people with normal blood pressure,” says Paul Whelton, professor of epidemiology at the Tulane School of Public Health and Tropical Medicine and lead author of the new guidelines.1 “And we have good data from lifestyle and drug trials that getting pressures below that level is beneficial.”

That range is now called “stage 1 hypertension.” (It includes many people who had “prehypertension,” according to the old guidelines.) But that doesn’t mean that half of all adults need to take drugs to lower their pressure.

“Some people think that this is a conspiracy by the pharmaceutical industry to sell more drugs,” says Whelton. “But not a single person on our committee had a relationship with industry.”

Whelton expects that only about 30 percent of people with stage 1 hypertension will need to start taking anti-hypertensive drugs. “Only those at higher risk will be in a range where a drug makes sense,” he notes.

Your estimated risk is high if your likelihood of having a heart attack or stroke during the next 10 years is greater than 10 percent. (You can calculate your risk here.)

“And if someone has already had a stroke or heart attack, that automatically puts them at high risk for having another one,” Whelton says.

Diet & Exercise

“Far from recommending that everyone who has hypertension get a drug, we have gone to great lengths to say that, first and foremost, the approach has to be dealing with the underlying problem, which is lifestyle,” Whelton explains.

And everyone, regardless of their blood pressure, should adopt a healthy lifestyle.
That starts with a DASH-like diet—eating more fruits and vegetables, beans, nuts, whole grains, and low-fat dairy, and less refined grains, salt, sugar, and red meat.

And it means moving more. “All forms of exercise, including weight lifting, will lower blood pressure,” says Whelton, “but the best evidence is for aerobic activity.” Aim for 90 to 150 minutes a week of either aerobic activity or resistance (strength) training, or a combination. (Click here for printer-friendly tips on how diet and exercise can help lower your blood pressure.)

What’s Your Pressure?

Chances are, your blood pressure hasn’t often been measured correctly. “The new guidelines put a lot of emphasis on getting accurate measurements, because we’re confident that in many instances, they’re not as good as they could be,” says Whelton.

“We would close down laboratories if they didn’t meet quality control procedures for measuring cholesterol. We wouldn’t fly in an airplane where the pilot didn’t follow the required pre-check for quality control. And yet, it’s no secret that blood pressure measurements done in clinical settings don’t follow guidelines very well.”
To solve the problem, the new guidelines explain how to get accurate blood pressure readings both at a doctor’s office and at home. (Check out our Measuring Blood Pressure: Getting it Right infographic for how to properly measure your blood pressure at home.)

“You don’t have to be a physician or a nurse to measure blood pressure accurately,” says Whelton. “Oftentimes, patients have the capacity to do it well because they’ve got more time and they’ll follow the protocol better.”

Regular readings at home can make a world of difference. For example, people with “white coat hypertension” only have high blood pressure in a doctor’s office.
“They have a cardiovascular risk that is much closer to people with normal blood pressure than to those with higher blood pressure, so they may not require treatment,” explains Whelton. “But they need to be monitored because their pressure can track upwards.”

People with “masked hypertension” are at greater risk. “These people have normal pressure in the doctor’s office, but high pressure out of the office,” says Whelton. “They’re even more concerning, because their risk is more similar to people who have high pressure all the time.”

Both are quite common, says Whelton—“Probably somewhere in the range of 15 to 25 percent of people.”

And don’t worry about one high reading, either at home or at the doctor’s office. “A diagnosis should only be made after averaging two or more measurements on two or more occasions,” says Whelton.


1 J. Am. Coll. Cardiol. 2017. doi:10.1016/j.jacc.2017.11.006.

Photos: ©Phase4Photography/

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6 Replies to “New guidelines mean you might have high blood pressure”

  1. I did not see any information about how age relates to blood pressure ?
    There is just so much “information” or “disinformation” out there now related to blood pressure, heart condition, high-low cholesterol, eat only this or that, etc.
    The “jock” crowd say you should have at least 10000 steps per day in your routine.
    Related to measuring blood pressure, I was shocked to read about the possible variation in readings for the different manufacturers cuff style machines. The particular model that I purchased at a reputable pharmacy read anywhere from 10 to 15 points different (higher) than the doctor office machine.

    1. Blood pressure varies throughout the day. Both measurements may have been accurate at the time they were taken unless you mean that you compared them at the same time.

  2. I share Howard’s concern about neglecting “old-age” in any high blood pressure discussion. High Blood pressure may not be all bad in the elderly. If you’re over 75 yrs. old, with high blood pressure and you’re overweight, there may be some protection for you from mental dysfunction. It’s not completely understood why high blood pressure and heaviness might become protective in old age. Not my thoughts, but something I read from Steven Reinberg, HealthDay Reporter, TUESDAY, Jan. 17, 2017 (HealthDay News).

  3. Oh really? To me it’s just another way for big Pharma to make more money… I dispute any research they have done because more profit is going to be the end result; Phooey!!!

    1. The new guidelines are not to start medications earlier, they are to start lifestyle changes earlier especially if there are no other risk factors for heart disease. The emphasis is on getting the normal public into a safer blood pressure range by working on several different fronts.. commerical foods putting lower salt guidelines on their products, public awareness and clinicians being on board to stop medicating at the drop of a hat and start educating and empowering people to live healthier lives. We are just living at a very unhealthy “norm” in our culture where being overweight and eating processed convenience and fast foods is just a normal part of life. I’m not being judgmental, everyone is conditioned by their environment and our standard western way of life is just not the healthiest culture.. we need to raise awareness, much like smoking cessation and smoke free awareness has been raised in the past 30 years.

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