Reports From the Field: New BP guidelines establish diagnosis of pre-hypertension

Level seeks to identify at-risk individuals early

New clinical practice guidelines for the prevention, detection, and treatment of high blood pressure have been released by the National Heart, Lung, and Blood Institute (NHLBI) in Bethesda, MD. The guidelines, approved by the Coordinating Committee of the NHLBI’s National High Blood Pressure Education Program, include altered blood pressure categories, featuring a new "pre-hypertension" level, which covers about 45 million adult Americans.

The guidelines also streamline steps by which doctors diagnose and treat patients and recommend the use of diuretics as part of the drug treatment plan for high blood pressure in most patients.

Here are the key aspects of the guidelines:

  • Former blood pressure definitions are changed as follows: Normal, less than 120/less than 80 mm Hg; pre-hypertension, 120-139/80-89; Stage 1 hypertension, 140-159/90-99; Stage 2 hypertension, at or greater than 160/at or greater than 100. The previous categories were optimal, normal, high-normal, and hypertension stages 1, 2, and 3.
  • Simplified and strengthened drug treatment recommendations. Use of diuretics, either alone or in combination, is recommended for most patients. The report says they currently are not being sufficiently used.
  • Use of additional drugs for severe hypertension or to lower blood pressure to the desired level. According to the report, most people will need two — and at times, three or more — medications to lower blood pressure to the desired levels.
  • The recommendation that clinicians work with patients to agree on blood pressure goals and develop a treatment plan.

The guidelines do not recommend drug therapy for those with pre-hypertension unless it is required by another condition, such as diabetes or chronic kidney disease, but it advises them to make any needed lifestyle changes.