Blood Pressure Recommendations Revised
While a growing number of Americans are seeking treatment for high blood pressure, approximately 30 percent of adults remain unaware of their
The Latest Numbers
Blood pressure numbers measure the force with which blood is pumped in and out of the heart. Hypertension occurs when blood moves through the arteries at a higher-than-normal pressure. That pressure is recorded as two numbers—the systolic pressure (top number) reflects the heart beating, while the diastolic pressure (bottom number) reflects pressure when the heart is relaxing between beats.
In 2003, a prestigious report called “JNC7“ recommended new blood pressure targets for Americans. In general these targets were set lower than had ever been proposed by a national advisory panel. Before JNC7, readings below 140/90—measured in millimeters of mercury (mmHg)—had been considered normal. According to JNC7 recommendations, normal blood pressure is below 120/80. The report also identified pre hypertension as a reading from 120/80 to 140/90, recommending lifestyle improvements to prevent blood pressure increases in persons who are prehypertensive. These new lower blood pressure recommendations are aimed at identifying individuals at risk for hypertension earlier, in order to prevent or delay the disease.
Blood Pressure as We Age
Since systolic blood pressure continues rising throughout life, the report especially emphasizes controlling systolic blood pressure in people over 50, noting that systolic readings more accurately predict cardiovascular disease and other health problems than do diastolic levels. Raised systolic blood pressure is also increasingly common as people age, reaching a prevalence of nearly 100% by age 80.
Doctors and patients have probably not been sufficiently vigilant in the control of hypertension among the elderly. A recent study published in the Journal of the American Medical Association (JAMA) describing data from well-known Framingham Heart Study suggests that while nearly three-fourths of octagenarians have high blood pressure, their conditions are frequently uncontrolled. More vigilant blood pressure testing and treatment in this age group could mean the difference between healthy later years and an incapacitating stroke or heart attack.
The most common diagnosis among Americans, hypertension accounts for 35 million primary-diagnosis office visits. Diabetes, smoking, age (older than 55 for men, older than 65 for women), and
The best treatment for hypertension that requires medication remains controversial. Most persons will need to take two or more drugs to achieve complete control of blood pressure, although sometimes these can be given as a single “combination pill”. Following the recommendations in the previous paragraph (especially increasing exercise and reducing salt and weight) will help to ensure maximum drug effectiveness. Most people can take blood pressure drugs with few side effects and have an excellent prospect of improving the length and quality of their lives. The guidelines in JNC7 should allow more Americans to work together with their doctor to appropriately diagnose and treat hypertension.
American Heart Association
American Society of Hypertension
National Heart, Lung, and Blood Institute
Agency for Healthcare Research and Quality (Press Release). Available at: http://www.ahrq.gov/news/press/pr2004/prehyppr.htm . Accessed August, 2005.
Lloyd-Jones, Donald M.; Evans, Jane C.; Levy, Daniel. Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community. JAMA. 2005; 294:466-472.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7): http://www.nhlbi.nih.gov/guidelines/hypertension//jnc7full.pdf .
Last reviewed August 2005 by
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