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Hypertension and Pre-hypertension

The National Institutes of Health issued new guidelines on the diagnosis of hypertension and "pre-hypertension" earlier this week. Key aspects of the new guidelines include:

  • A new “prehypertension” level and merging of other categories. The new report changes the former blood pressure definitions to:
    • Normal - less than 120/less than 80 mm Hg;
    • Prehypertension - 120-139/80-89 mm Hg;
    • Stage 1 hypertension - 140-159/90-99 mm Hg;
    • Stage 2 hypertension - > 160/100 mm Hg.
  • The 1997 categories were optimal, normal, high-normal, and hypertension stages 1, 2, and 3. Stages 2 and 3 were combined because their treatment is essentially the same.

    The guidelines do not recommend drug therapy for those with prehypertension unless it is required by another condition, such as diabetes or chronic kidney disease. But the report advises them-and encourages those with normal blood pressures-to make any needed lifestyle changes. These include losing excess weight, becoming physically active, limiting alcoholic beverages, and following a heart-healthy eating plan, including cutting back on salt and other forms of sodium. For FOH staff who detect prehypertension levels in clients, it would be prudent to:

    1. Recommend lifestyle changes, including smoking cessation if applicable
    2. Follow-up with additional readings if available and
    3. Refer clients to their primary healthcare
    provider for treatment evaluations, especially if they have other risk factors

    As in the 1997 guidelines, the new report recommends Americans follow the DASH-Dietary Approaches to Stop Hypertension-eating plan, which is rich in vegetables, fruit, and nonfat dairy products.

    Simplified and strengthened drug treatment recommendations to include the use of diuretics and other drug classes in initial regimens such as angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, beta-blockers, and calcium channel blockers. According to the new report, most persons will need two, and at times three or more, medications to lower blood pressure to the desired level.

    The guidelines also recommend clinicians work with patients to agree on blood pressure goals and develop a treatment plan.

    For more detailed information on the new guidelines, please go to the following NIH website: www.nhlbi.nih.gov/new/press/03-05-14.htm

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