Blood pressure measures the force of blood pushing against artery walls as your heart circulates blood. It’s recorded as two numbers: systolic (when the heart beats) and diastolic (when the heart rests). Persistently elevated levels, known as hypertension, can lead to serious conditions like heart disease, stroke, kidney problems, and cognitive decline. Health organizations develop guidelines to help manage this condition.
The 2017 Guideline Update
A significant shift in blood pressure recommendations occurred in 2017 with new guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA). These guidelines redefined hypertension, lowering the diagnostic threshold from 140/90 mmHg or higher.
The 2017 update reclassified hypertension to 130/80 mmHg or higher. Normal blood pressure is now less than 120/80 mmHg. Readings between 120-129 mmHg systolic and less than 80 mmHg diastolic are categorized as “elevated,” replacing “prehypertension.”
Stage 1 hypertension is defined as 130-139 mmHg systolic or 80-89 mmHg diastolic. Stage 2 hypertension begins at 140 mmHg systolic or 90 mmHg diastolic or higher. This redefinition significantly increased the number of adults diagnosed with hypertension. For most adults, the new guidelines also set a lower treatment goal of less than 130/80 mmHg.
A History of Evolving Advice
Blood pressure guidelines have undergone several revisions over decades, reflecting an evolving understanding of cardiovascular health. The first Joint National Committee (JNC) guideline was issued in 1977, initially focusing on diastolic blood pressure as the primary measure of risk. Subsequent JNC reports refined recommendations for defining and treating hypertension.
The JNC 7 report (2003) defined hypertension as 140/90 mmHg or higher. However, the JNC 8 report (2014) introduced controversy by relaxing targets for older adults, recommending 150/90 mmHg or higher for those aged 60 and above. This divergence showed the dynamic nature of medical guidelines. The 2017 ACC/AHA guidelines ultimately superseded these earlier JNC recommendations, informed by newer research.
Driving Forces Behind Guideline Changes
Updates to blood pressure guidelines are driven by continuous scientific evidence from extensive research. New findings from large-scale clinical trials significantly shape these recommendations. For instance, the Systolic Blood Pressure Intervention Trial (SPRINT) showed that aiming for a systolic blood pressure target under 120 mmHg resulted in fewer cardiovascular events and lower mortality rates.
Researchers also conduct meta-analyses, combining data from multiple studies for robust evidence on intervention effectiveness. This improved understanding confirms the continuous relationship between blood pressure levels and cardiovascular disease risk. Guidelines are updated to incorporate these insights, aiming to improve public health outcomes by preventing disease and reducing mortality.
What the Updated Guidelines Mean for You
The updated guidelines directly impact individuals, especially regarding diagnosis and management. Many previously considered to have “elevated” blood pressure or “prehypertension” may now be categorized as Stage 1 hypertension. This reclassification means more individuals will be diagnosed with hypertension, even if their numbers are slightly above the previous normal range.
Understanding your personal blood pressure readings in light of these new thresholds is important. Regular blood pressure monitoring, both at home and during doctor visits, provides feedback to track your numbers. For those newly categorized with elevated blood pressure or Stage 1 hypertension, healthcare providers often emphasize lifestyle modifications first. These include adopting a heart-healthy diet low in sodium, engaging in regular physical activity, managing weight, and moderating alcohol consumption. If lifestyle changes are insufficient or if there are additional cardiovascular risk factors, medication may be recommended to achieve the lower blood pressure targets.