Guidelines for high blood pressure: New guidelines for categorizing patients with hypertension are causing blood pressure to rise among some experts involved in the debate.

Late last year, the American College of Cardiology and the American Heart Association lowered the threshold for defining hypertension as well as for drug treatment in certain patients.

Guidelines for high blood pressure

Under the new guidelines, 31 million more people in the United States will be classified as having hypertension. A report published in JAMA Internal Medicine says the new guidelines risk putting patients at risk.

Dr Katy Bell, lead author of the report and a senior researcher at the University of Sydney in Australia, says the new guidelines follow a general pattern across all medical specialties, in which disease definitions are often broadened rather than narrowed.

“These expanded definitions generally designate people as being in poor health, even if they are at low risk of disease and therefore likely to cause harm. The full benefits and harms of the expanded definition of hypertension do not appear to have been considered in the development of the new guidelines,” she told Healthline.

Bell's report found that 80% of people newly diagnosed as hypertensive under the guidelines are expected to receive no benefit from the definition.

“We estimate that approximately 25 million Americans who now qualify as hypertensive… will be at low risk for cardiovascular disease. To our knowledge, there is no evidence that labeling people as low risk as someone with hypertension provides any advantage to them,” she said.

But Bell says it's possible to classify these hypertensive people as at risk for mental health problems.

“Identifying a person with hypertension increases their risk of anxiety and depression compared to that of hypotensive people, with the same blood pressure,” she said.

According to previous guidelines, the threshold for diagnosing hypertension in adults was a reading of 140/90 mmHg (a blood pressure reading of 140 over 90). Under the new guidelines, the threshold is lowered to 130/80.

Diagnosis can prompt action

Dr. Matthew Budoff is a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), as well as program director of the Division of Cardiology at Harbor-UCLA Medical Center.

He adds that while raising awareness about hypertension and setting a goal of blood pressure readings below 130/80 are important, the new definitions may not be suitable.

“I think the label and definition of high blood pressure as 130/80 is not appropriate. Too many patients will have a value above 130 and will be labeled. I don’t think it causes harm, but it is both unnecessary and likely to lead to higher insurance premiums and insurance difficulties,” he told Healthline.

Even so, Budoff says the benefits to the 31 million Americans now classified as hypertensive far outweigh the risks. He says sometimes it takes a diagnosis to inspire people to act.

“I think more people are responding positively with a diagnosis of something. Several patients this week have recently been diagnosed with marginal diabetes. They immediately started losing weight, eating better and watching their fat/carb intake,” he said.

The potential changes a person can make following a diagnosis of hypertension could be beneficial.

“The benefits far outweigh the risks. More lifestyle changes, salt restriction, exercise, weight loss will lead to better results and a healthier life for all. There is no data indicating that any of these lifestyle changes will reduce life expectancy, nor is there any data indicating that any medication does more harm than good. If drugs did more harm than good, the FDA would never approve them,” he said.

Long-term benefits

Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, said implementing the guidelines would result in significant benefits for men and women of all ages.

“Reduction in heart attacks, strokes, heart failure, kidney failure and premature cardiovascular deaths. The benefits far outweigh the potential risks,” he told Healthline.

Fonarow does not agree with Bell's assertion that 80% of people newly diagnosed with hypertension would obtain no benefit from this type of diagnosis.

“People whose high blood pressure is in the range classified in the new guidelines as high blood pressure are at increased risk of cardiovascular events, and this risk is modifiable. It is important to take significant proactive steps to reduce this risk through lifestyle changes,” he said.

“Lowering blood pressure to the levels recommended in the new guidelines has clear and compelling benefits across all age groups, in men and women. The JAMA Internal Medicine analysis is misleading and does not take into account the long-term benefits of achieving and maintaining recommended blood pressure levels,” he said.

The Centers for Disease Control and Prevention (CDC) reports that 360 people in the United States die from hypertension each year. That’s nearly 000 deaths per day.

According to Fonarow, the biggest risk is not over-analysis, but under-analysis.

“There are hundreds of thousands of hospitalizations and tens of billions of dollars in expenses directly attributable to failure to diagnose, treat and control hypertension according to guidelines. This is the clear, present and permanent danger to the health system,” he said.