On November 13, the American Heart Association and the American College of Cardiology issued new guidelines for the diagnosis and treatment of hypertension. Physicians are now advised to diagnose this common condition at a lower systolic and diastolic level. The net result of this change is that approximately half (46%) of the population will now have this diagnosis, with the effect most pronounced on younger adults. Experts estimate that using the new diagnosis categories will triple the prevalence of treatable hypertension in males under 45 and double it for females under this age as well.
The new diagnostic categories are:
· Normal: BP less than 120/80 mm HG
· Elevated: Systolic between 120-129 and diastolic less than 80
· Stage 1: Systolic between 130-139 or diastolic between 80-89
· Stage 2: systolic at least 140 or diastolic at least 90 mm Hg
Why the change? Well it is not because doctors are looking for business, or that the pharmaceutical industry is in need of new customers. Rather, it is based on population research that consistently shows that for every 10 points above the normal of 75mm HG, a person's risk for cardiovascular disease such as heart attacks and strokes actually doubles. In other words, a person whose average diastolic is 95 (20 points above 75), would have approximately four times the chance of developing these serious conditions. In the past, doctors would label someone with an elevated diastolic of 80-90 as 'Pre-hypertension' and perhaps advise close follow-up, but this category has been completely eliminated in the new guidelines to emphasize the serious potential of this risk and to encourage active treatment to prevent bad outcomes.
Now here comes the good part that may help put some skeptics at ease: By 'treatment' the experts acknowledge that for many individuals who have not already had a complication such as a stroke or heart disease, the best treatment is actually the life-style changes such as decreased salt intake, weight loss, avoidance of alcohol excess, increased exercise, etc. Also, the new guidelines go into more detail about getting the diagnosis correct by incorporating home BP monitoring to avoid 'white-coat hypertension' which is when some individuals will have higher results in a doctor's office due to anxiety In other words, drug therapy is not being pushed earlier on asymptomatic individuals just because the diagnostic categories have changed. Rather, more aggressive follow-up would be advised after the life-style modifications, with consideration of drug therapy only if there is progressive movement into Stage 1. Patients with Stage 2 disease are more likely to be successfully treated with proven combinations of two medications rather than relying on just one.
How will these changes affect the health of America? The realist in me still predicts that likely many folks will not be able to make the changes to avoid drug therapy. Getting up earlier every morning to exercise, or pushing the second-helpings and dessert plate away every evening takes a lot more effort than taking a pill. However, if just a few patients and their docs do make the effort to stay in closer contact and not be lulled into a false sense of security by believing they are only 'borderline', then they increase their chances that they will be around next year to wish their friends and family: Merry Christmas, Happy Hanukah/Solstice/Kwanza and Healthy New Year !!