New tip sheet helps clear confusion about hypertension

Photo: Bryan Costin via Flickr

If you’re confused about standards for managing hypertension in older adults, you’re not alone. When the American Heart Association and American College of Cardiology updated the guidelines in November 2017,  millions of adults suddenly faced a new diagnosis of high blood pressure. Adding to the confusion: some medical organizations disagreed with the revisions, opting instead to manage their older patients according to prior standards.

The concern is that the new standards could lead to over treatment of people who have very little risk of developing cardiovascular disease. Under the new criteria, optimal blood pressure is defined as 120/80 mm Hg for adults over age 18. The threshold for a hypertension diagnosis dropped from 140/80 mm Hg to 130/80 mm Hg. That includes community-dwelling older adults who can tolerate antihypertensive medications.

The new guidelines mean 103 million Americans have high blood pressure, up from 72 million under the former standards, Reuters reported. That’s about a 14 percentage point increase in the prevalence of hypertension in the U.S., but only a 1.9 percentage point increase in adults requiring antihypertensive drug therapy, as this article in the Annals of Internal Medicine explains. This original study, published in Circulation, further breaks out the crude prevalence of hypertension among US adults.

That is, unless a patient is treated by a family practitioner.

The American Academy of Family Practitioners (AAFP) disagrees with the methodology used by the AHA,  choosing instead to continue endorsing the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, These criteria were developed by the Eighth Joint National Committee (JNC8), which has higher thresholds (less than 150 mm Hg) for adults age 60 and older. This New York Times op-ed sums up the controversy well. And Bloomberg News advises people to take the new recommendations with a “grain of salt.”

In the United States, hypertension accounts for more cardiovascular disease (CVD) deaths than any other modifiable risk factor and is second only to cigarette smoking as a preventable cause of death for any reason, according to the American College of Physicians. Reporting on hypertension can be stressful and confusing. This new tip sheet can help sort out the facts from fallacies.

UPDATE: This post has been corrected to clarify that the increase in the prevalence of hypertension in the U.S. is by percentage points, not percentage.

5 thoughts on “New tip sheet helps clear confusion about hypertension

  1. Avatar photoJack McCain

    If 72 million Americans had hypertension under the old guidelines, the addition of another 31 million under the new guidelines represents an increase in prevalence of 43%, not 14% as is claimed in this article (3rd graf). The arithmetic is simple; at a glance, any writer or editor should see that 31 million is approaching half of 72 million.
    Yes, I know this article simply repeats a statement from the linked Annals of IM article, but that article cites another article, from Circulation, as the source of these statistics. If you examine that article (, you will find this statement in the abstract (supported by Table 3, p 113): “According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among US adults was 45.6%… and 31.9% …, respectively, and antihypertensive medication was recommended for 36.2% … and 34.3% … of US adults, respectively.”
    Doing some simple arithmetic again, you can see that the difference between 45.6% and 31.9% represents an increase of about 14 percentage POINTS, which is not the same as an increase of 14 percent.
    Likewise, it follows from the percentages in the abstract that the increase in Americans needing medication for hypertension under the new guidelines is 1.9 percentage POINTS, not 1.9 percent.
    It’s bad enough that Annals of IM misreported some findings from the Circulation study, but it is distressing that health care journalists have repeated the error.
    Don’t add to the confusion! Check the math and check the references!

  2. Avatar photoRoxanne Nelson

    The new “guidelines” are certainly a windfall for the pharma industry, as it will get more people on drugs. And in most cases, drugs they don’t need. There has been a continuous push to “identify” more health problems that need to be treated, and this is one of them. I was very happy to see many organizations and healthcare professionals contest these new recommendations. Americans are the most medicated society and certainly far from the healthiest.

  3. Avatar photoLiz Seegert Post author

    thanks for your comment Roxanne! Unfortunately older adults are reluctant to question their doctors and too few docs really sitting down and individualizing medication therapy based on a person’s age. There are other, non-dharma approaches to managing hypertension. Few make money off them.

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