New Blood Pressure Guideline Sets Lower 130/80 Threshold

Expanded guideline means more than 100 million people have high blood pressure.

The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg. This means that more than 100 million adults will now have high blood pressure, though many will be unaware of the diagnosis.

Paul Whelton

The 192 page guideline (the executive summary is only 112 pages) is the long-awaited update of the US hypertension guideline. The last “official” guideline was the NIH’s seventh Joint National Commission, which was published in 2003. In 2013 the NIH announced that it would no longer be responsible for developing influential guidelines like the JNC guideline for hypertension and the Adult Treatment Panel (ATP) guideline for cholesterol.

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure was released today at the American Heart Association meeting in Anaheim and published simultaneously in Hypertension and the Journal of the American College of Cardiology.

The new guideline eliminates the category of prehypertension. The new blood pressure categories are:

  • Normal:<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;
  • Hypertensive crisis: Systolic >180 and/or diastolic >120.

The guideline authors said that the the impact of the new guideline will be greatest among younger people. They said the prevalence of hypertension in people under the age of 45 would triple among men and double among women.

At a news conference, Paul Whelton the chair of the writing committee, said that the new guideline contains 106 recommendations. The first hypertension guideline contained only 6 recommendations, “so we’ve come a long way,” he said.

In an accompanying paper published in Circulation, Paul Munter (University of Alabama at Birmingham) and colleagues used national survey data to estimate the impact of the new guideline. The prevalence of hypertension will increase from 31.9% under JNC7 criteria to 45.6%. This works out to 103.3 million people who will be categorized as having high blood pressure.

In the new guideline antihypertensive drug therapy is recommended for 36.2% of US adults, or 81.9 million adults, while 21.4 million are recommended for nonpharmacologic therapy only. The new guideline increases the number of US adults recommended for drug therapy by 4.2 million.

The new definition also mean that a greater percentage of adults taking antihypertensive drugs have failed to reach goal, rising from 39% in JNC7 to 53.4% in the new guideline. Intensification of drug therapy is recommended for those who fail to reach goal.

The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. Many people newly defined as hypertensive because they have a systolic blood pressure between 130-139 mm Hg or a diastolic blood pressure between 80-89 mm Hg do not need to take drugs. Adults in this range who are at low cardiovascular risk and who are less than 65 years of age should be treated with lifestyle changes while those at high cardiovascular risk or who are 65 or older should receive drug therapy.

The new guideline also places a strong emphasis on improving blood pressure measurement both in the office and at home. Use of an automated measurement system, similar to that used in clinical trials, is recommended in the office. Blood pressure measurements taken at home are also endorsed, particularly to help identify people with white coat hypertension.

The new guideline represents a partial but not complete acceptance of the 2015 SPRINT trial, which initially appeared to support a radically more aggressive systolic target of 120 mm Hg. SPRINT tested an antihypertensive strategy using the conventional goal of 140 mm Hg against the more aggressive goal of 120 mm Hg in high risk patients. The results favored the more aggressive treatment, but many hypertension experts were critical of the trial and said the 120 goal should not be broadly adopted.

The 130 systolic blood pressure goal in the guideline suggests that the writing committee found a middle ground or compromise.

Harlan Krumholz (Yale University) said that the guideline represents “a major change in the recommendations, opting for more people being labeled with hypertension and recommended for treatment. The challenge now is immense; how to communicate the change, the strength of the evidence behind it; and the options available to patients – and ensure that patients’ goals and preferences are steering the clinical course. Otherwise we will have what we do today, many prescriptions that are unfilled and untaken; many people who clear knowledge of their risk and risk factors; and too many preventable events in people who otherwise would have chosen pharmacological and non-pharmacological strategies to reduce risk.

The AHA went to extraordinary efforts to control the flow of information about the new guideline. An embargoed copy of the guideline was only made available to the media 7 hours before the publication time, leaving little opportunity for journalists to obtain outside opinion or perspective.


  1. Joseph Chemplavil, MD, FACE says

    I hope this is the final answer on the blood pressure target controversy in hypertension management. The target range of B.P. 110 to 130 / 75 to 85 mm Hg seems to have maximum benefit in reducing heart attack, stroke and death as well as renal failure in my 40 years of experience of treating patients of all ages. Regular home blood pressure monitoring needs to be routine in clinical practice especially in elderly patients with multiple co-morbid conditions, irrespective of whether they are treated by primary care physicians or specialists.

    • I think that all this is causing too much anxiety. 140/90 blood pressure is fine if you have a healthy lifestyle.

    • Aidan D Day says

      I think America is in trouble doc, I’m 43 & I just received a monitor (for the wrist, from Amazon 2day), I k ew mine would be a little high (138/86, but I didn’t expect to see my 12 y/o son @ 130+/87 bpm 84. I told him we need to take in less sodium, less red meat, more water. At his age, that’s not cool. Do U have any other suggestions for improving our #’s besides those we already plan to work on? I’d definitely appreciate your feedback, thanx.

  2. “the executive summary is only 112 pages”: well said, Mr Husten.

    Speaking only for myself, I find the earnest promulgation of …. well, I find all this stuff quasi-religious.

    What must I achieve, oh Master, to be one of God’s elect?

    Get your BP below the theological threshold! Pray to the saints of cardiology! Finger a holy relic! Burn a heretic! Slaughter a calf! Inspect chicken entrails! Honour our food taboos!

  3. See the recommendations of the Canadian Therapeutics Initiative group that revised the same data but came to very different conclusions

    • Thank you Colin! I came across this while in the midst of crafting an email to a friend who is hysterical about my failure to take meds to go below 130.

  4. Leslie Estes says

    This says it all: “The new guideline increases the number of US adults recommended for drug therapy by 4.2 million.”

    More pharma propaganda.

  5. Pharmaceutical industry: we need more money, so we will change the parameters. Wake up people, you are being conned, once again.

  6. Loving the comments and add ,..perhaps a Heart Foundation representative should sit atop Everest ,.treat the HBP.The human body self regulating and adaptive,…..Your ethical mantle (do no harm) is broken.Legacy of a billionaire Rockafella and his mob.

  7. Jeffrey Patten says

    It’s amusing that this new standard is so precise when the brachial pressure is so naturally variable and the central aortic pressure – the pressure supplying flow where it matters most, to the vital internal organs, heart itself, brain – is less subject to changes and usually a fair degree lower.
    What is the precise desirable aortic pressure?

    Aortic pressure remains quite unknown, being inconveniently inaccessible as it is. Central and brachial pressures can be quite different from each other in some individuals and not so different in others. Any one individual’s central pressure cannot reliably be extrapolated from his brachial without knowing the actual relationship… invasively.
    How high or low is your aortic pressure?

    Likewise, any one individual’s exercise/active pressure – brachial or central – cannot be extrapolated from his resting pressure. Then there’s the whole question of if that matters. Pressure supplying flow to skeletal muscles can react quite strongly to the varying stresses placed on those muscles. What is happening internally at the time??

    Known unknowns and unknown unknowns.
    It’s possible to be quite precise and utterly wrong.

    • Jeffrey Patten says

      So, if we carefully follow procedure, we can know, more-or-less, what the pressure in the upper arm is at the time of measurement.

      This is a very crude approximation of what the pressure supplying the vital organs is doing across time.

      I’m suggesting here that this antique technique tells us far to little for us to do the best we could for the hypertensive patient depending on us.

      There are now non-invasive ways of determining central pressure. Is central pressure reading the technology we will look back from and ask ourselves, “What were we thinking for all that wasted time?”?

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