Getting your blood pressure measured is a staple of the annual doctor’s visit. But, in a series of new guidelines, the diagnostic criteria for high blood pressure (a.k.a. hypertension) have been updated—for the first time in 14 years. So, even if your readings haven’t changed, you might not be where you think you are anymore.
The guidelines, released this week, were created by a committee including members from the American Heart Association, American College of Cardiology, and nine other partners, Paul Whelton, M.D., chair of the committee and lead author on the new recommendations, tells SELF. The full recommendations were simultaneously published in Hypertension and the Journal of the American College of Cardiology.
According to the new guidelines, anyone with blood pressure above 130/80 is considered to have hypertension.
First off, the level of normal blood pressure hasn’t changed—it’s still 120/80. Anything less than that is great (until you experience symptoms of low blood pressure, that is). The top number refers to your systolic blood pressure (a measurement of the pressure your blood exerts when your heart beats) and the bottom is your diastolic (a measurement of the blood’s pressure between beats).
Previously, those with systolic pressure readings in the 120 to 139 range would have been put in the prehypertension category and wouldn’t have been considered hypertensive until they got to 140/90, Dr. Whelton explains. However, the new guidelines eliminate the prehypertension category, putting everyone with systolic pressure readings between 120 and 129 and a diastolic reading below 80 in a new “elevated” category. In addition, those with systolic pressure between 130 and 139 or a diastolic reading between 80 and 89 are now considered to be in stage 1 hypertension. Above 140 systolic or 90 diastolic, you get into the stage 2 hypertension. And having pressure over 180 systolic or 120 diastolic is considered a hypertensive crisis.
Here’s a chart from the American Heart Association that might help:
With these new guidelines, the rate of hypertension among women under 45 is expected to double, and the rate for men under 45 is expected to triple, Dr. Whelton says. So, knowing where your blood pressure’s at is a crucial health marker for you and your doctor—and it might get a little confusing with these changes. Here’s why it’s worth finding out your numbers sooner rather than later:
1. High blood pressure doesn’t usually cause any noticeable symptoms.
In rare cases, hypertension can cause shortness of breath, headaches, or nosebleeds, the Mayo Clinic says. But in the vast majority of cases there are no symptoms whatsoever, Roxane Mehran, M.D., Director of Interventional Cardiovascular Research and Clinical Trials at Icahn School of Medicine at Mount Sinai, who was not involved with creating the guidelines, tells SELF. “That’s the biggest problem—it’s the biggest silent killer,” she says. That means you can’t rely on those symptoms as reasons to check in with your doctor about blood pressure.
And it’s important to note that we’re not talking about a one-time reading that you get at your annual appointment, although that is the best place to start. As Dr. Whelton explains, patients may have different measurements in and outside of the doctor’s office. So, after seeing a potentially concerning reading at a routine appointment, the goal is to actually get multiple readings in the office and at home—ideally including readings at night—to get a full picture before making a diagnosis, he says.
2. Hypertension is at the root of heart disease and, if left untreated, it can cause organ damage.
“High blood pressure is a risk factor for several things,” including conditions affecting the heart and the rest of your body, Mary Norine Walsh, M.D., President of the American College of Cardiology, tells SELF. That includes heart attacks, strokes, and heart failure as well as bleeding in the brain and kidney damage that can eventually necessitate dialysis.
Why such a huge impact? “With each heartbeat, [the heart is] beating against higher pressure,” Dr. Mehran explains, meaning there’s an “increased workload with every heartbeat.” That causes the heart muscles to thicken and makes it even harder for the heart to pump blood effectively. Hypertension “is often very silent from a clinical standpoint,” Dr. Walsh says, “but the downstream effects are extremely severe.”
3. It’s possible to treat high blood pressure with lifestyle changes if caught early on.
Once you get into the elevated level (systolic between 120 and 129 and diastolic below 80), “you have to look at that patient in a different light,” Dr. Mehran says. Although treatment isn’t necessarily the most urgent, depending on your other health markers, your doctor may encourage you to think about lifestyle modifications, including changes to your diet, cutting back on alcohol, or increasing physical activity levels. Once your numbers get higher than that, those lifestyle changes become essential. And, at levels beyond that, your doctor may consider bringing in medications as well.
But the goal with the new guidelines is to prevent that level of severity by emphasizing treatment at lower pressures, Dr. Whelton says, and by stressing the role you play in making that happen. “This is a really important message,” Dr. Walsh says, “[patients] can impact their own blood pressure with the choices they make with regard to food and exercise.”
Additionally, the guidelines offer recommendations for monitoring your blood pressure at home (for instance, verify that the device you’re using is accurate with your doctor). So if you’re curious about your blood pressure or how to monitor it, check in with your doc—but don’t discount your own power in keeping yourself healthy.