Stricter criteria for high blood pressure! Am I now hypertensive and required to take medications?

High blood pressure has always been a major health concern to both patients and healthcare professionals. It is a chronic disease with many devastating complications such as heart disease and stroke when not controlled properly.

Under the new guideline from AHA, this is classified as Stage 1 hypertension while it used to be Pre-hypertension under the previous guideline.

The new guidelines from AHA (American Heart Association) 2017

With the release of the new guideline for hypertension (the medical jargon for high blood pressure), it certainly struck fear in many people; the reason being they had just introduced more stringent criteria in diagnosing hypertension.

A huge change from the previous guidelines (JNC 7 guidelines) published in 2003, part of the group of patients who were once considered to be pre-hypertensive will now be diagnosed with hypertension. Under this new guideline, approximately 50% of the American population (as well as Malaysian population) will be diagnosed as hypertensive.

 

The new, the old and the local

Let’s take a brief look at how the new guideline differ from the old Joint National Committee 7 (JNC 7) guideline published in 2003 and our own Malaysian Hypertension Clinical Practice Guideline (CPG) published in 2013. To understand more on what do the terms Systolic Blood Pressure (BP)and Diastolic BP mean, please refer to our infographics here.

From the figure above, certain patients who used to fall under the Pre-hypertension range (JNC 7) and the Normal or High Normal range (Malaysia CPG) now fall into the category of hypertension under the new AHA guidelines; specifically, those with a diastolic BP of 80-89 mm Hg. These changes were made in lieu of new and more reliable data which shows that even with a diastolic BP of 80-89 mm Hg, the risk for heart disease can increase by as much as twofold when compared to people with a diastolic blood pressure of less than 80 mm Hg.

If we scrutinized the basis of why the JNC 7 classifies hypertension the way it did, we find that it was based on older studies whereby the people who fall under the pre-hypertension range has increased risk of heart diseases (when compared to people with normal blood pressure), but this increased risk was not statistically significant. To put this in simple terms, this means that the increased risk of heart disease (found in the study) may be due to chance rather than being a real risk and thus considered as unreliable by medical standards.

Lastly, the Malaysia Hypertension CPG classification is based on the classification suggested in JNC 6 which was published in 1997 and shall not be discussed here.

 

“My blood pressure falls under Stage 1 hypertension in the new guidelines. Should I be worried? Do I have to rush to see my doctor?”

 

For now, the Ministry of Health Malaysia have yet to announce any changes in our national guideline. Furthermore, other countries and regions such as Europe have yet to make any changes. Their current guideline is more or less in line with JNC 7. Therefore, there is no reason to panic.

People who fall under Stage 1 hypertension in the JNC 7 or Malaysia CPG should definitely see their doctor for advice and diagnosis.

For those who fall under Stage 1 hypertension under the new AHA guidelines (but NOT JNC 7 or Malaysia CPG) can try the lifestyle modifications as suggested here first until your local health ministry make an announcement regarding whether or not to adopt the new guideline for local use.

If you have any burning questions, or are worried about your blood pressure readings, do not hesitate to speak to your pharmacist or doctor for professional advice.

References:

  1. Whelton P, Carey R, Aronow W, Casey D, Collins K, Dennison Himmelfarb C 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. Hypertension. 2017;:HYP.0000000000000065.
  2. Kaplan N. The 6th Joint National Committee Report (JNC-6): New Guidelines for Hypertension Therapy from the USA. The Keio Journal of Medicine. 1998;47(2):99-105.
  3. The JNC 7 Hypertension GuidelinesThe JNC 7 Hypertension Guidelines. JAMA. 2003;290(10):1312.
  4. James P, Oparil S, Carter B, Cushman W, Dennison-Himmelfarb C, Handler J et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA. 2014;311(5):507.
  5. Management of Hypertension 4th Edition. Putrajaya: Ministry of Health, Malaysia; 2013.
Pou Wee Gan
Pou Wee Gan

M.Pharm, MBBS, BCPS, R.Ph

A pharmacist first, then a medical doctor. An avid tea drinker and an occasional poet.

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