The blood pressure reading of 140/90 mm Hg had been ingrained in our minds as the hallmark of hypertension. However, an update to the guideline has now reexamined this number in addition to taking a closer look at the prevention, detection, and evaluation of hypertension. Researchers developed the new guideline based on data and studies suggesting that a lifelong blood pressure reading below 130/80 mm Hg will substantially lower risk of CVD and chronic kidney disease incidence, particularly among individuals with diabetes and other comorbidities.
The 2017 ACC/AHA guideline was recently published in the Journal of the American College of Cardiology in November and reflects an update of the previous Joint National Committee Report published in 2003. Since its original publication 14 years ago, the new guideline includes the latest information from studies regarding blood pressure-related risk of CVD, defines blood pressure thresholds for nonpharmacologic and pharmacologic interventions, and outlines treatment goals and strategies.
To prevent and treat hypertension, blood pressure should be categorized as normal, elevated, stage I hypertension, or stage II hypertension.
Normal Blood Pressure: <120 and <80 mm Hg
Elevated Blood Pressure: 120-129 and <80-89 mm Hg
Hypertension Stage I: 130-139 or 80-89 mm Hg
Hypertension Stage II: ≥140 or ≥90 mm Hg
The most noticeable change in the guideline is that hypertension is to be diagnosed at 130/80 mm Hg vs 140/90 mm Hg. The hypertension diagnosis must “use an average of ≥2 readings obtained on ≥2 occasions to estimate” one’s blood pressure level.1 It also must take into account where a blood pressure reading is obtained (ie, out of office vs physicians office, where white coat effect may falsely elevate blood pressure). According to the new guideline, 46% of US adults have stage I or II hypertension.1 These new statistics may be encouraging to assist health care teams to begin earlier interventions, further reducing risks and complications.
The guideline emphasizes a patient-centered, team-based approach for the prevention and treatment of hypertension. It reinforces the importance of influencing modifiable risk factors and highlights five main contributors such as the following:
- Sodium intake
- Potassium intake
- Physical activity
- Reducing alcohol consumption
The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits and vegetables, whole grains, low-fat dairy products, and decreased intake of total fat and saturated fat, is touted in the review as being impactful for the reduction of hypertension. This reduction in blood pressure also may be due in part to incorporating more foods rich in potassium, magnesium, calcium, and fiber—all of which may blunt the effects of a high-salt diet. Physical activity also is included in the recommendations, as aerobic and dynamic resistance training for 90 to 150 minutes per week and isometric resistance training in three sessions per week can attenuate the rise in blood pressure.
Promising interventions also were noted, although there wasn’t enough supporting evidence to clearly suggest a direct correlation with hypertension. These include use of probiotics, supplementation with calcium or magnesium, stress reduction, and behavioral therapies such as yoga and meditation.
Should dietitians monitor blood pressure in their private practices and outpatient facilities? It may be an area to explore. However, standardization of proper protocols and procedures may be necessary to assist dietitian-led practices. As an RD, being an advocate for your client’s health is key in helping them understand the new guideline. Asking additional questions regarding your client’s physical, emotional, psychosocial, and environmental influences can assist dietitians in reassessing and redefining our clients’ goals for the management of hypertension.
— Heather Shasa, MS, RDN, is a freelance writer from New Jersey with experience in the retail, clinical, subacute, and community settings. She’s passionate about CVD and diabetes, with a particular interest in nutrition for fathers. Follow her nutrition journey at www.weldingwellness.com and @weldingwellness on social media.
1. Reboussin DM, Allen NB, Griswold ME, et al. Systematic review for the 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 Foundation/American Heart Association Task Force on Clinical Practice Guidelines [published online November 7, 2017]. J Am Coll Cardiol. doi: 10.1016/jacc.2017.11.004.