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Dear Doctor: I'm so confused by the new blood pressure guidelines. Yesterday, my blood pressure was normal. With the new guidelines, though, I'm now considered to have high blood pressure. Is my doctor going to put me on medication?

Dear Reader: Ever since the new blood pressure guidelines were released by the American College of Cardiology and the American Heart Association in November, we've been getting quite an earful. We're hearing not only from our patients, but from family and friends as well. People are surprised, upset, worried and, as you state in your letter, just plain confused.

The truth is that blood pressure goals have long been (and quite likely will always remain) controversial among the medical community. Back in 2014, when a panel of medical experts loosened blood pressure guidelines for some older Americans, there was an immediate backlash. Now, with guidelines being tightened, the debate has erupted again. Rather than focus on the history of blood pressure guidelines and the various schools of thought behind each iteration, we think it's more useful to talk about where things stand now, how the current guidelines affect us and what changes each of us can make to get better numbers.

Heart disease, which accounts for one quarter of all deaths in the United States, is the leading cause of death among both women and men. High blood pressure, or hypertension, is second only to smoking as a preventable cause of heart attack and stroke. At this time, guidelines state that normal blood pressure falls into a range below 120/80. The top number, known as systolic pressure, refers to the pressure in your arteries as your heart contracts. The bottom number is diastolic pressure, which is the pressure in your arteries between heartbeats. When taken together, the numbers offer a snapshot of your cardiac health.

People with a top number that falls between 120 and 129, and whose bottom number falls below 80, are considered to have "elevated" blood pressure. A top number of 130 to 139, and a bottom number of between 80 and 89, is considered to be stage 1 high blood pressure. Readings greater than 140/90 are stage 2 high blood pressure. Both stage 1 and 2 require medication.

Part of the uproar over these new guidelines is they are likely to push close to half of all Americans out of the normal range. However, this doesn't automatically mean blood pressure medication for everyone. In fact, the aim of the guidelines update is to give people ample warning of pending blood pressure problems. Because it has no obvious symptoms, high blood pressure is known as the silent killer. By catching changes early, people with elevated blood pressure can take steps to achieve healthier numbers through lifestyle changes and interventions, such as:

  • Losing weight.
  • Quitting a smoking habit altogether.
  • Exercising regularly.
  • Watching your diet.
  • Cutting back on salt.
  • Limiting alcohol.
  • Cutting back on caffeine.
  • Reducing stress.
  • Keeping regular track of your blood pressure.

We're sure you've heard this all before. But knowing what to do isn't the same as actually doing it. We believe this is an important discussion, so we'll be back next week with details about how and why each of these steps is important to your good health.

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Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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