If you think your blood pressure levels are normal, you may need to think again.

New blood pressure guidelines issued by the National Heart, Lung, and Blood Institute (NHLBI) move as many as 45 million Americans from a normal or high-normal blood pressure category into a newly-established “pre-hypertension” category.

New Blood Pressure Categories in Adults

Blood Pressure Level (mm Hg)

Systolic Pressure Diastolic Pressure


  • Less than 120
  • AND
  • Less than 80


  • 120 - 139
  • OR
  • 80 - 89


  • 140 and higher
  • OR
  • 90 and higher

Until now, blood pressure levels up to 139 over 89 mm Hg were considered normal or high-normal. The new guidelines classify normal blood pressure as less than 120 over 80 mm Hg. People with pre-hypertension have blood pressure levels between 120 over 80 and 139 over 89 mm Hg. What is considered high blood pressure (140 over 90 mm Hg or higher) has not changed in the new guidelines.

High blood pressure (hypertension) is a major risk factor for heart disease, the leading risk factor for stroke and heart failure, and can lead to kidney problems. Individuals with pre-hypertension are at increased risk of developing high blood pressure and need to take action to prevent heart disease, stroke and kidney disease.

“People in the pre-hypertension category don’t necessarily need medications, but they do need to make lifestyle changes to prevent hypertension,” explains Gainesville cardiologist Khawaja Anwar, M.D. “These changes include following a healthy diet, exercising, cutting back on salt, limiting alcohol intake, and not smoking.”

The new guidelines are an update of earlier recommendations released in 1997. The change is based on a review of scientific evidence released since 1997. The evidence consistently shows that the risk of death from heart disease and stroke begins to increase at blood pressure levels as low as 115 over 75 mm Hg. Authors of the guidelines report that, beginning at 115 over 75 mm Hg, the risk of death doubles with every 20 over 10 mm Hg rise in blood pressure.

The new guidelines also report that Americans’ risk of developing high blood pressure is higher than previously thought. Approximately one-fourth of the U.S population has high blood pressure. The chance of developing high blood pressure increases with age. People who have normal blood pressure at age 55 have a 90 percent chance of developing hypertension.

“Many people who have high blood pressure don’t even know they have it,” Doctor Anwar warns. “These guidelines mean that it is more important than ever to have your blood pressure levels checked.”

For people older than 50, the guidelines state that an elevated systolic pressure (the top number of a blood pressure reading) is a more important risk factor for cardiovascular disease than diastolic pressure (the bottom number of a blood pressure reading). Unfortunately, it is also more common and harder to control.

As in the earlier guidelines, the report recommends the DASH diet, an eating plan that is rich in fruits, vegetables and non-fat dairy products.

The guidelines shift from previous versions by simplifying and strengthening drug treatment recommendations. The guidelines report that diuretics ("water pills") are an inexpensive, effective and underused treatment for hypertension. The report also states that most people with high blood pressure will require two or more drugs to lower blood pressure, often a diuretic and drugs such as ACE inhibitors, beta-blockers or calcium channel blockers.

“This information reminds us that we need to take hypertension very seriously. Adopting a heart-healthy lifestyle is important, even if your blood pressure is normal,” states Doctor Anwar. “The sooner you take action, the better your chances of protecting your health.”

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