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Hypertension & Stroke

2004 Edition

A New Definition of “Normal” Blood Pressure
Find out whether you have “prehypertension,” and if so, what you can do to reduce your risk of developing full-blown hypertension.

You’ve been getting your blood pressure checked regularly, and your readings are consistently below 130/85 mm Hg. According to previous guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, which were released in 1997, you had normal blood pressure. Now, according to the committee’s newest recommendations, you might fall into a new category called prehypertension. This classification was created to help motivate both doctors and their patients to take important steps to prevent hypertension and to reduce the risk of cardiovascular events, such as heart attacks and strokes.

Blood Pressure Classification: The Old vs. the New

According to the old recommendations, “optimal” blood pressure was a systolic pressure less than 120 mm Hg and a diastolic pressure lower than 80 mm Hg. People with these values now fall into the new “normal” category. The previous categories of “normal” (systolic 120 to 129 mm Hg or diastolic 80 to 84 mm Hg) and “high-normal” (systolic 130 to 139 mm Hg or diastolic 85 to 89 mm Hg) have been combined into the new “prehypertension” category. Therefore, prehypertension is defined as a systolic blood pressure between 120 and 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg.

New evidence about the risks associated with elevated blood pressure levels prompted experts to update the old blood pressure classifications. “We have found that damage to the arteries begins at fairly low blood pressure levels—levels previously considered ‘normal,’” Aram V. Chobanian, M.D., the committee’s chair, said at a press conference at which the guidelines were released. (The guidelines were later published in May 2003 in the Journal of the American Medical Association.)

The guidelines point out that the risks of health problems like heart attacks, strokes, heart failure, and kidney disease begin to increase when blood pressure levels rise above 115/75 mm Hg. For people 40 to 69 years of age, for example, every increase of 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure above this threshold doubles the risk of dying of a stroke or other cardiovascular event.

What To Do

The new guidelines don’t recommend that most people with prehypertension take antihypertensive medication, but they do say that these individuals should use a combination of lifestyle modifications to reduce their blood pressure, prevent the development of hypertension, and lower their risk of cardiovascular events. These modifications include losing weight, adopting a diet that emphasizes fruits and vegetables, restricting sodium intake, exercising, and consuming alcohol only moderately.

Such lifestyle measures are also recommended for people with higher blood pressure levels, including those on medication. Using a combination of lifestyle modifications reduces blood pressure more than using only some of them.

Still, certain people with prehypertension should be treated with medication. According to the guidelines, such persons include those with diabetes or chronic kidney disease. These individuals may need medication to reduce their blood pressure to below 130/80 mm Hg.


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Hypertension & Stroke

The Hypertension and Stroke White Paper from the Johns Hopkins White Papers series is an annual, in-depth report written by Johns Hopkins physicians.



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