Healthy Blood Pressure at Any Age:  Understand the Guidelines

The American College of Cardiology’s updated blood pressure guidelines — here’s how they may affect you.

Nearly one out of every two Americans has high blood pressure, making it one of the most common conditions in the country. Rates of hypertension, or high blood pressure, rose significantly in 2017 when the American College of Cardiology put new blood pressure guidelines in place. Those updated standards allow doctors to diagnose and treat more people for hypertension earlier.

Before 2017, under the old guidelines, 140/90 was the threshold for a high blood pressure reading. Today, that threshold has been lowered to 130/80, identifying more people at risk for high blood pressure. “It took a while for the medical community to realize that when you follow that higher threshold, many of the patients were already experiencing some target organ damage of the heart and brain,” says Maria Delgado-Lelievre, M.D., a cardiologist and founder and director of the Comprehensive Hypertension Center at UHealth.

One of the most significant changes Dr. Delgado has noticed in the latest hypertension guidelines is the shift in how physicians think about the disease itself. “We used to focus mainly on numbers — checking blood pressure readings and prescribing medications accordingly. The new guidelines encourage us to see hypertension as a lifelong journey, closely intertwined with other cardiovascular risk factors,” she says.

This means doctors are now looking more comprehensively at patients who may also have issues with cholesterol, diabetes, or existing heart disease. For these patients, treatment becomes more proactive and aggressive.

Dr. Delgado explains what she’s looking for with the new numbers and how you can help keep your blood pressure in a healthy range.

Why blood pressure guidelines matter at any age

Changing the blood pressure guidelines matters because it helps doctors identify who may be at risk for complications from high blood pressure. This allows doctors to decide who needs treatment, such as exercise, nutritional changes or medication to lower their blood pressure.

The 2017 guidelines also changed for teenagers over the age of 13. Their blood pressure is now calculated like that of adults, so anything over 130/80 is considered high. “In the past, looking at blood pressure in children was a disaster because you had to go by percentile and make calculations on a huge table based on age,” says Dr. Delgado.

Reflecting this change, the Comprehensive Hypertension Center at the University of Miami will begin seeing patients as young as 13 for cardiovascular health evaluations this spring. 

Most young people who have a family history of hypertension fall into the category of “elevated blood pressure.” Recognizing elevated blood pressure early offers a valuable opportunity to assess cardiovascular risk sooner and intervene effectively through non-pharmacological strategies.

Non-pharmacological treatment means lifestyle changes, often the most challenging to implement. Social determinants of health that depend on life circumstances, like easy access to healthy food, make lifestyle changes particularly difficult.

These include:

• Healthier eating habits
• Better sleep
• Stress management
• Regular exercise
• Smoking cessation
• And more

Not every hypertensive patient is the same.

Treating patients according to their specific health circumstances and history matters. “Each person with hypertension carries their unique set of risks, and we need personalized treatment plans tailored specifically to address these individual risks,” says Dr. Delgado.

Knowing your family history of hypertension is crucial to early detection, even in people as young as teens. “Someone with an inherited risk of heart disease –– even if they aren’t yet hypertensive –– can show signs of vascular abnormalities that a cardiologist can detect with a blood test,” says Dr. Delgado.

Hypertension is a ‘silent killer’

Unmanaged and untreated high blood pressure can place you at risk for complications such as:

• High cholesterol
• Stroke
• Heart attack
• Heart failure
• Heart disease
• Dementia
• Kidney disease
• Vision loss
• Sexual dysfunction (in males especially)

This is because blood pressure is the force your heart exerts to pump blood through your blood vessels.

When your blood pressure is high, the extra force can damage your blood vessels.

As blood vessels are damaged, the body tries to repair the areas with patches of sticky cells. Over time, other substances like plaque and fat can stick to the “patched” areas, narrowing the vessel and decreasing blood flow.

“Hypertension causes a lot of stress on the heart and blood vessels and produces a form of inflammation. If the body has to deal with that regularly, it becomes chronic, causing the heart to overexert itself in order to function the same way it once did,” says Dr. Delgado.

High blood pressure is often called a “silent” killer because there are not usually clear signs of high blood pressure until it has negatively impacted your health. That’s why regularly checking your blood pressure at your doctor’s office is so important.

How to get an accurate blood pressure reading

If you’ve ever had your blood pressure taken while feeling nervous, annoyed or stressed at the doctor’s office, you know how easy it is to have a false high blood pressure reading. A blood pressure reading only measures your system at a specific moment in time.

The flip side of that phenomenon is that younger people living a healthy lifestyle can be overlooked for high blood pressure when at the doctor’s office. “Especially in kids and young adults, a high blood pressure reading in the office just means they’re told to relax and there’s no workup or evaluation,” says Dr. Delgado.

You may consider getting a more accurate reading by consistently tracking your blood pressure over time. The following are a few tips to get the most accurate blood pressure reading:

• Avoid caffeine, nicotine, and alcohol for at least 30 minutes before measuring your blood pressure.
• Stop by the bathroom because a full bladder can artificially raise blood pressure.
• Try to sit comfortably in a calm environment for 5-10 minutes.
• Sit with your back supported, feet flat on the floor and your legs uncrossed.
• Avoid exercise or vigorous physical activity right before a reading.
• Support your arm at heart level with a table or armrest.
• Wrap the cuff snugly around your bare upper arm above your elbow. The cuff should cover roughly 80% of your upper arm circumference. Relax your arm and hand.
• Avoid talking or moving during the reading.
• Record readings consistently at similar times each day if tracking blood pressure over time.

How to maintain a healthy blood pressure

The good news is, thanks to easy-to-understand guidelines, doctors can quickly identify if you are at risk for high blood pressure. If your doctor finds you’re at risk, they may recommend some lifestyle changes as well as medications to lower your blood pressure.

Many natural remedies are effective in helping to lower blood pressure. These include:

• Eating a diet rich in fruits, vegetables, and whole grains
• Limiting salt
• Avoiding processed meats, sugar and alcohol
• Getting a minimum of 150 minutes of moderate-intensity aerobic activity every week
• Minimizing stress
• Quitting smoking

No matter how healthy you eat or how active you are, a genetic predisposition to high blood pressure is a major factor in high blood pressure. Talk to your doctor about blood pressure screening and keep your regular checkups to monitor your blood pressure.

The new guidelines can help more people proactively stay healthy.

“By embracing these new perspectives, we as physicians can empower our patients more effectively, addressing not only medical but also socio-economic factors, and ultimately help them achieve better health outcomes and improved quality of life,” says Dr. Delgado.

Wendy Margolin is a contributor for UHealth’s news service.

Tags: Blood pressure monitoring tips, Cardiovascular health, Dr. Maria Delgado-Lelievre, Hypertension management, Preventing heart disease