When Your Blood Pressure Reading Is Abnormal

Understanding the 2017 AHA/ACC Guidelines

In This Article

For a long time, normal blood pressure (BP) was defined as 120/80 mmHg. However, the American Heart Association (AHA) and the American College of Cardiology (ACC) revised their guidelines in 2017, redefining what an optimal blood pressure range is and when the blood pressure is considered too high or too low.

While 120/80 used to be considered normal, the AHA/ACC guidelines today define three levels of abnormal blood pressure values:

  1. Prehypertension: Systolic (upper) reading of between 120 and 139 mmHg and a diastolic (lower) reading of 80 to 89 mmHg is now considered to be prehypertension. Doctors today are watching blood pressures in this range far more carefully than in the past.
  2. Stage 1 hypertension: A blood pressure reading of 140/90 mmHg is the cutoff for Stage 1 hypertension. Stage 1 hypertension may or may not be treated with medicines depending on lifestyle and other risk factors.
  3. Stage 2 hypertension: Systolic pressures readings above 160 mmHg or diastolic pressures above 100 mmHg is now classified as Stage 2 Hypertension, a serious condition that warrants immediate medical treatment.

AHA/ACC Recommendations

The AHA and ACC have categorized blood pressure ranges to indicate various stages of hypertension.

Blood Pressure Category Systolic Diastolic
Normal less than 120 and less than 80
Prehypertension 120 to 139 or 80 to 89
Stage 1 High Blood Pressure (hypertension) 140 to 159 or 90 to 99
Stage 2 High Blood Pressure (hypertension) 160 or higher or 100 or higher
Hypertensive crisis (requiring emergency care) Higher than 180 or Higher than 110

Systolic blood pressure is generally given more attention in adults 50 and over given that the number tends to rise steadily as people age. Reasons include decreased arterial elasticity and the increased accumulation of arterial plaque.

Both of these events contribute to increased rates of atherosclerosis ("hardening of the arteries") and coronary artery disease (CAD).

Considerations

Accurate blood pressure measurements are essential for diagnosing and treating high blood pressure. A specific set of techniques and procedures have been developed for obtaining the most accurate blood pressure readings possible.

Medical professionals may not completely follow these guidelines. It is important for you as a patient to be able to identify when proper protocol is being followed, or not.

If Your BP Is High

A single elevated reading is not usually enough to diagnose hypertension. Typically speaking, a high blood pressure reading will prompt your doctor to take several more readings over time to see whether there is a trend. Alternately, you may be asked you to monitor your blood pressure at home.

If your blood pressure readings are consistently high, you and your doctor will need to discuss treatment strategies.

The first-line treatment of high blood pressure usually focuses on lifestyle changes, such as a weight loss and exercise plan, as well as a low-sodium, reduced-fat diet.

In fact, the AHA and ACC recommend adopting these strategies as a means of preventing high blood pressure in the first place. If these strategies are not successful, medications (such as ACE inhibitors, diuretic, calcium channel blockers, or beta-blockers) may be recommended.

Whether or not pharmaceutical treatment is prescribed, it is essentially to remain linked to medical care so that your condition can be monitored and treatment revised as needed.

Hypertension Doctor Discussion Guide

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  1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice GuidelinesJ Am Coll Cardiol. 2018;71:e127-e248. doi:10.1161/HYP.0000000000000066