Under Pressure: Revisions to high blood pressure guidelines

By Daniel Kotzen

This week, the American Heart Association and the American College of Cardiology set new guidelines for high blood pressure, lowering the definition from 140/90 to 130/80 millimeters of mercury. With 1 in 3 American adults having high blood pressure and 610,000 people dying of cardiovascular disease in the United States each year, the ramifications of the recommendation are certainly worth considering. [1]

The new guidelines stem from the largest federal study of its kind to date – the Systolic Blood Pressure Intervention Trials (SPRINT). During the trial involving more than 9,300 participants, researchers investigated the optimal way to treat high blood pressure for adults aged 50 or above who were at high risk for hypertension.[2] The study found that patients who were assigned a systolic blood pressure goal of less than 120 mm Hg, compared with the previous level of 140 mm Hg, exhibited a 38 percent lower relative risk for heart failure and a 43 percent lower relative risk for death from cardiovascular disease. These staggering improvements certainly explain why the guidelines are being altered, but this raises another natural question concerning the impact these changes have on the population at large.

By generally lowering the threshold for hypertension, the number of adults in the United States with high blood pressure will rise from 72 million to 103 million – almost half of all American adults. While the impact on the corporate setting, with a younger and typically healthier population, will not be as dramatic as the US population more generally, Vitality data revealed that – on average – there will be a 10 percent absolute increase in the proportion of individuals deemed hypertensive. The increase of an at-risk population means that these individuals will have to be monitored more regularly, medicated, and be given recommendations for improved lifestyle behaviors, which is all positive.

With regard to better monitoring, individuals will be encouraged to track their blood pressure on a more regular basis, making them more informed and – ideally – more proactive in their management of their blood pressure. While additional monitoring comes at a cost, this also represents a unique opportunity for innovation in the space, wherein monitoring should be made cheaper and more accessible to all.

It is heartening that lifestyle-related behaviors have been given more prominence in the revised guidelines and treatment plans have become more tailored to the individual. Historically, people with a systolic blood pressure exceeding 140 mm Hg (and 150 mm Hg for individuals aged 60 or over) were recommended to be placed on a medication regiment. In the revised formulation, however, there is more personalization and physicians are recommended to check their patient’s cardiovascular risk score. While lifestyle improvement recommendations are made for all individuals in this 130-139 mm Hg systolic blood pressure risk category, it is only those who have a 10-year cardiovascular risk exceeding 10 percent that are also placed on a medication regiment.

The treatment of high blood pressure will require a multi-pronged approach involving not only medication, but ongoing monitoring and important conversations around how improvements to various lifestyle-related behaviors can impact one’s high blood pressure. It is in such instances that evidence-based solutions become more important than ever especially as they pertain to weight loss, heart-healthy diets, increased physical activity, and alcohol reduction. In the physical activity sphere, Vitality Active Rewards with Apple Watch, for example, uses behavioral economics principles to nudge individuals across the risk spectrum to improve and sustain their physical activity levels.

The new blood pressure guidelines are a positive moment in that greater attention is focused on identifying and managing individual risk and requiring discussion on lifestyle modifications at a lower threshold. While adequate supportive infrastructure will have to be in place to cater to a higher number of at-risk individuals, the revised guidelines appear to be a means by which to save more lives, reduce future costs stemming from poorly managed or unidentified blood pressure risk, and elevate the importance of lifestyle-related risks in discussions about health more generally. In encouraging healthy discussion amongst a broader swathe of Americans, it is a welcome step forward towards silencing the “silent killer.”


Daniel Kotzen, Product Analytics Manager, loves storytelling in its many forms – from statistical analyses and infographics to art and restaurants reviews.

[1] Centers for Disease Control and Prevention. Heart Disease Facts. Accessed from: https://www.cdc.gov/heartdisease/facts.htm. Last accessed: November 15, 2017.

[2] The Sprint Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. The New England Journal of Medicine. 2015-11-26;373:2103-2116.

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