New high blood pressure guidelines: Think your blood pressure is fine? Think again…

Monique Tello, MD, MPH
Monique Tello, MD, MPH, Contributing Editor


The definition of the diagnosis of high blood pressure and the decision-making process surrounding treatment have traditionally been quite individualized (read: all over the place). Personally, I invite these stricter measures, because they are accompanied by solid research, logistical guidance, and useful management strategies.

However, a whole heck of a lot of people just got pulled into a significant medical diagnosis.

Let’s review what’s new.

A new definition of high blood pressure (hypertension)

(Please note that all numbers refer to mm Hg, or, millimeters of mercury.) The guidelines, in a nutshell, state that normal blood pressure is under 120/80, whereas up until Monday, normal was under 140/90.

Now, elevated blood pressure (without a diagnosis of hypertension) is systolic blood pressure (the top number) between 120 and 129. That used to be a vague category called “prehypertension.”

Stage 1 high blood pressure (a diagnosis of hypertension) is now between 130 and 139 systolic or between 80 and 89 diastolic (the bottom number).

Stage 2 high blood pressure is now over 140 systolic or 90 diastolic.

The measurements must have been obtained from at least two careful readings on at least two different occasions. What does careful mean? The guidelines provide a six-step tutorial on how, exactly, to correctly measure a blood pressure, which, admittedly, is sorely needed. My patients often have their first blood pressure taken immediately after they have rushed in through downtown traffic, as they’re sipping a large caffeinated beverage. While we always knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading.

New recommendations on monitoring blood pressure


If you now have high blood pressure, you may not need meds… yet

The guidelines also outline very clearly when a diet-and-lifestyle approach is the recommended, first-line treatment, and when medications are simply just what you have to do. Thankfully, the decision is largely based on facts and statistics. For the elevated blood pressure category, medications are actually not recommended; rather, a long list of evidence-based, non-drug interventions are. What are these interventions? Things that really work: a diet high in fruits and vegetables (such as the DASH diet, which is naturally high in potassium); decreased salt and bad fats; more activity; weight loss if one is overweight or obese; and no more than two alcoholic drinks per day for men, and one for women. Simply changing what you eat can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.

For people with stage 1 hypertension who don’t have cardiovascular disease and are at low risk for developing it (less than 10% risk of an event within 10 years), lifestyle changes are still the way to go. (Risk is determined using a well-researched, widely used formula available here.)


Optimizing treatment of high blood pressure


And why should this all matter to you?


Much is being made of the fact that the new definitions of high blood pressure will mean roughly half of all US citizens will be considered to have high blood pressure, but when you really look at the numbers, as cardiologists already have, not that many more people will actually be advised to take medications. Although the public has good reason to be suspicious of “big pharma,” that’s not what this is about.

Diet and lifestyle changes are powerful medicine. Even if your blood pressure is normal now, you can help to prevent it from becoming elevated starting today. Eat more fruits, veggies, and whole grains, and limit foods high in sodium and unhealthy fats. Be as physically active as possible.

There is a lot more in the very long, detailed executive summary, including specific guidance for various populations, myriad diseases, and special circumstances, but this is the gist of it. The document is free, and available here.

Related Information: Starting to Exercise


  1. Liz Feinauer


    American Heart Association. (2015). The American Heart Association’s diet and lifestyle recommendations. Retrieved from

  2. azure



  3. Char barton

    We live on hype daily about many things. Goalsetters we are. This is just another one, designed to raise our blood pressure about yet another thing. We gotta live/work harder-better -smarter. Sleep the same way. Dam. I feel my blood pressure rising already! Maybe less driven work, play, judgment; more relaxing, letting it go, loving what we are and have- is a better answer.

  4. Stavros

    Not only table salt adds sodium to our food but also sodium glutamate, a flavor enhancer used in processed foods and restaurants. Does someone knows if this is as bad as adding salt?

  5. Elaine Shiner

    High-blood-pressure medications used to have a reputation for causing symptoms that were worse than the disease. I hope that situation has changed. I’m sure that you’re sincere when you write that this is not about more medications, but, having observed the evolution of our health-care system for many decade now, I’m skeptical.

  6. Sanjay

    Normal BP level (130/80) may not be uniform across all the regions of the world owing to different life style and eating habbits. What is experts’ opinion on this?

  7. Bhupender Kataria


  8. Arnold Baise


    • Doc Mil


      For example, did you know it takes 10,000 mammograms done yearly for 10 years, in order to just prevent 10 breast cancer deaths?

      Of note, I am a primary care doc.

  9. Grace Williams

    Grace Williams
    I’m just turn 56 years and for the past 8 month my blood pressure was high, now it is even dangerously high. Was 154 over 82 now it’s 189 over 82 or 92 . It really scares me, I know that I can have a stroke or heart attack. My weight is 191 and my height is 5’7. Eats health. No meat or dairy. Just stress out from work. Need some help.

    • Nita

      Exercise may help. Walking at a brisk pace for 1/2 hour most days, then adding 15 minutes to the walk every week. It doesn’t have to be done all at once-walk 15 minutes in the morning, 15 at lunch, and 15 after supper. Get a friend or neighbor to walk with you and the time will go by quickly.

  10. Ghpkap

    What about the food industry? I cook almost all my meals, when I go out to eat, if I do not specify no seasoning, I can’t even take one bite due to the excessive amount of salt added to the food.
    I think at this point any restaurant or food industry that adds excessive salt should be taxed commensurately to help defray the cost for health care. The salt is killing us.

    I travel extensively, and our country by far uses too much salt in processed and restaurant food.

    Perhaps you can can help educate people and force the food industry to change! One can only hope.

    • John O

      Give me a break. Most people don’t use restaurants for their every-day eating— it’s a special occasion intended to be more indulgent than a normal meal. Your distaste for salt shouldn’t affect the level of seasoning in my Birthday dinner.

      • Brenda

        salt it yourself, john o

      • azure

        Or, restaurant meals could be prepared with less salt, and if you like more, you could ADD salt from the salt shakers I’ve always seen on the table of every restaurant I’ve eaten in.

        That way everyone is accomodated–you can add as much salt as you like, those who don’t like or need to cut back on salt can do so.

        Seems like an easy solution to me.

    • Nita

      I agree. Eating at home is the only sure way to keep your bp down. Way too much salt in restaurant meals.

  11. Jeanne Miller

    Why do I get up in the AM with enormously high B P? Usually 180 over 85 with a 53 pulse?

  12. Monique Tello, MD, MPH
    Monique Tello, MD, MPH


  13. Sara Shannon

    Please stop saying “unhealthy fats.” Tell people what the sources of those unhealthy fats are specifically.

  14. Sotirios

    If you and your colleges at AHA are right about cvd, how come their president got a heart attack recently? Get real and level with us tha you do not know what is the cause and next u don’t know how to prevent or treat it right ,