New Hypertension Guidelines and the Data Implications

Created by 
American Medical Association (AMA)
New Hypertension Guidelines and the Data Implications


Recently, the American Heart Association, the American College of Cardiology and nine other groups redefined high blood pressure as a reading of 130 over 80, down from 140 over 90. The change means that 46 percent of U.S. adults will now be considered hypertensive. Under the previous guideline, 32 percent of U.S. adults had high blood pressure.

The new guideline eliminates the category of prehypertension. The new blood pressure categories are:

  • Normal: <120/80 mm Hg
  • Elevated: Systolic between 120-129 and diastolic less than 80 mm Hg
  • Stage 1: Systolic between 130-139 or diastolic between 80-89 mm Hg
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg mm Hg
  • Hypertensive crisis: Systolic >180 and/or diastolic >120 mm Hg

In the new guideline antihypertensive drug therapy is recommended for 36.2% of US adults, or 81.9 million adults, while 21.4 million are recommended for nonpharmacologic therapy only. The new guideline increases the number of US adults recommended for drug therapy by 4.2 million.

The new definition also mean that a greater percentage of adults taking antihypertensive drugs aren't reaching that goal, rising from 39% in JNC7 to 53.4% in the new guideline. Intensification of drug therapy is recommended for those not reaching that goal.

The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. Many people newly defined as hypertensive because they have a systolic blood pressure of 130-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg do not need to take drugs. Adults in this range who are at low cardiovascular risk and who are less than 65 years of age should be treated with lifestyle changes while those at high cardiovascular risk or who are 65 or older should receive drug therapy.

This panel discussion seeks to discuss the data implications of these new blood pressure recommendations, such as the following questions:

  • Would you consider querying your current roster of patients to identify the group newly classified as hypertensive?
  • Should a clinical system attempt to more aggressively identify all patients with hypertension? Would regular data reports be made available for this? How are those data reports run?
  • Calculating cardiovascular risk is an important decision point. Are there tools that help clinicians do this?
  • Effectively prescribing lifestyle and diet becomes more important. Are there technological ways to do this? How do you document and manage this?
  • Can we make aggressively managing hypertension easier with algorithms? Who decides those algorithms? How can those be technological implemented?
  • Effectively seeing a patient’s medication history will become more important with aggressive BP management. How are EHRs handling this?
  • Will running reports of how many patients are or are not at goal be useful to clinical systems in getting more patients to goal?
  • There’s more emphasis on home blood pressure checks and monitoring. How is that data entered into the clinical system?
Cami Chen
Jonathan Bonnet
Annemarie Hirsch
Jennifer Robinson