Target BPs are much lower
Last week the American Heart Association (AHA) and the American College of Cardiologists (ACC) published new guidelines in the diagnosis and treatment of high blood pressure.
What are the new numbers and what do they mean?
Many people will be surprised to find out they now have “elevated” high blood pressure, which could be a reading as low as 120/70, or Stage 1 hypertension at 130/80 rather than 140/90 (the old threshold).
The new blood pressure guidelines are:
- Normal: Under 120 over 80
- Elevated: Top number 120-129 and bottom 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
It’s estimated that an additional 30 million people will now be diagnosed with high blood pressure. Many of those will be under the age of 45.
Make sure your blood pressure is accurate
With this new lower target, it’s more important than ever to make sure your blood pressure reading is accurate!
It’s unfortunately easy to get artificially high readings.
One thing that has always bothered me when I go in for my annual (or biennial) exam is how poorly blood pressure is measured. The task—even though it’s pretty important—is usually given to a medical assistant or nurses’ aide. No offense, but they don’t have the same training as a nurse or a physician.
Taking an accurate blood pressure is a skill, and it takes a lot of practice to become proficient.
Honestly, even nurses and doctors-to-be aren’t perfect at it.
A couple months ago, a study came out that revealed medical students failed miserably at taking BPs. Only 1 out of 159 did it properly! I can only assume, and hope, they get better further along in their training.
As a nursing student at one of the best nursing schools in the country, I didn’t get much instruction, either. I found out several years after graduating that I was doing it improperly (yikes!) and took steps to educate myself better.
I’ve known nurses to have trouble getting a blood pressure on a patient and because of frustration or impatience just give up and enter an old BP into the chart.
So if nurses can’t always be bothered to get a BP right, I don’t have much faith in medical assistants.
If you’re the patient, what can you do? Here are some tips to help you make sure your blood pressure is done properly and doesn’t result in a falsely high reading.
- Empty your bladder before having your blood pressure measured. Discomfort or pain will raise your blood pressure.
- Sit with your feet on the floor. Don’t cross your legs or have your feet dangling from a stool or exam table. And don’t lie down!
- Make sure the blood pressure cuff fits comfortably yet snugly around your upper arm. A poorly fitted cuff is a major cause of inaccuracies. The standard cuff is fine for a medium-sized arm, but if you are very small or very large, ask the nurse or MA about using a different cuff.
- Keep your arm relaxed and at heart level. Too often your arm is left hanging at your side, resting in the nurse’s lap, or—worst of all—held stiffly out in front of you. Position yourself so your arm is resting comfortably on a table, counter, or exam table.
- Don’t talk. How many times has a nurse or MA tried to engage me in conversation when they’re taking my BP?? No!
- Ask for it to be done again. If the reading is high or just higher (or lower) than normal for you, ask that it be done again in a few minutes, or after your appointment.
- Be aware that being cold (flimsy gown?) or anxious (white coat hypertension!) can also raise your blood pressure.
Most doctors will repeat your blood pressure if it’s on the high side. And generally it takes several high blood pressure readings over a period of time to make a diagnosis. No one should be treated based on a single high blood pressure reading.
Will more people will be overtreated?
Elevated blood pressure is a risk factor for heart disease, stroke and kidney problems. It’s often—usually—caused by lifestyle factors, such as smoking, obesity, lack of exercise, poor diet, etc.
But my first thought with these new lower guidelines was “Great, more people taking more drugs.”
For otherwise healthy adults with an elevated or Stage 1 blood pressure, it’s being “suggested” that care providers not prescribe drugs but rather focus on lifestyle changes.
That sounds great in theory—a huge chunk of America could benefit from healthier lifestyles—but will it work in practice?
Coaching patients to quit smoking, eat better and exercise more is hard. And it takes time. Lots of time.
The reality in today’s health care system is that physicians have precious few minutes with each patient, maybe only 5 to 10 minutes for a typical office visit.
From a patient’s point of view, quitting smoking, eating better and exercising more is hard. And it takes time…I know many people who would rather take medications than change anything about their lives.
So I’m worried more doctors and patients will decide it’s easier and faster to resort to drugs to meet the new lower blood pressure targets.
While most health care providers seem to be happy with the new guidelines, those that take a less-is-more approach to health (like me) are skeptical about the benefits and concerned about the risks of overtreatment.
A national goal of 130 …may lead to many being overmedicated—making their blood pressures too low.
I fear many [primary-care practitioners] will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary—and that usually means more medications.
Time will tell if these new blood pressure guidelines will improve lives and lower healthcare costs, or put more people on long-term medications and drive up healthcare costs.
For more information about blood pressure and lifestyle changes, check out the Mayo Clinic’s Blood Pressure page.