New AHA/ACC Guidelines Lower High BP Threshold

Hypertension should be treated earlier with lifestyle changes and potentially with medication at 130/80 mm Hg rather than 140/90 mm Hg, according to new hypertension guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC).

The new guidelines, which address the detection, prevention, management, and treatment of hypertension, were written by a panel of 21 scientists and health experts following a review of more than 900 published studies. They are the first hypertension guidelines to be published in more than 10 years.

Approximately 46% of the US population now meets the criteria for hypertension, as opposed to 32% of adults with the previous guidelines. Blood pressure categories in the new guideline, which has eliminated the category of prehypertension, include:

  • Normal (less than 120/80 mm Hg)
  • Elevated (systolic blood pressure [SBP] between 120 and 129, and diastolic blood pressure [DBP] below 80)
  • Stage 1 (SBP between 130 and 139, or DBP between 80 and 80)
  • Stage 2 (SBP of at least 140 mm, or DBP of at least 90)
  • Hypertensive crisis (SBP of at least 180 and/or DBP of at least 120, with patients requiring prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage)

Other changes to the hypertension guidelines include:

  • Medication should only be prescribed for Stage 1 hypertension if a patient has already experienced a cardiovascular event such as a heart attack or stroke, or has a high risk for heart attack or stroke based on age, the presence of diabetes, chronic kidney disease, or calculation of atherosclerotic risk.
  • It should be recognized that many patients will need 2 or more types of medications to control their blood pressure, and that patients may better adhere to taking pills if multiple medications are combined into a single pill.
  • Risk factors for high blood pressure that should be considered in a patient’s plan of care include socioeconomic status and psychosocial stress.

—Christina Vogt


High blood pressure redefined for first time in 14 years: 130 is the new high: American Heart Association/American College of Cardiology guidelines [press release]. Anaheim, California. November 13, 2017. Accessed November 14, 2017.