According to the World Health Organization, hypertension, or high blood pressure, is the number one cardiovascular risk factor, as well as the world’s greatest risk factor for death and disability.
Because of hypertension significant role in causing life-changing illnesses and death, medical researchers have invested significant time and resources into studying risk factors and treatment recommendations. These efforts resulted in new guidelines, which were released in September 2017.
For the first time since 2003, the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines released new guidelines concerning high blood pressure in adults.
As a Houston, Texas medical malpractice lawyer, part of my job is to remain up-to-date on clinical guidelines and standards of care applicable to all kinds of medical and healthcare diagnoses and treatments. While these guidelines are designed for healthcare providers, they are also important in litigation of medical negligence cases, because they define what a doctor should have done in diagnosing and treating hypertension.
New adult high blood pressure categories
The new categories are as follows:
Normal blood pressure: Less than 120/80 mm Hg
Elevated blood pressure: Systolic (upper number) between 120-129 mm Hg and diastolic (bottom number) less than 80 mm Hg
Stage 1 hypertension: Systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg
Stage 2 hypertension: Systolic 140 mm Hg or greater or diastolic 90 mm Hg or greater
Hypertensive crisis: Systolic over 180 mm Hg and/or diastolic over 120 mm Hg, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
The most significant change is that the 2017 guidelines lower the definition of high blood pressure from 140/90 mm Hg to 130/80 mm Hg.
If you are familiar with the previous guidelines, you will note that this list does not include the category of pre-hypertension, which has been eliminated.
New treatment recommendations
The task force recommends that doctors prescribe medication for Stage 1 hypertension only if a patient has already had a cardiovascular event such as a stroke or heart attack, or is at high risk of heart attack or stroke based on age, or other medical conditions, like diabetes mellitus, chronic kidney disease, or calculation of atherosclerotic risk (related to high cholesterol).
One of the significant issues in treatment of high blood pressure is finding a way to help patients properly take the recommended medications. The task force recognized that many people will need to take two or more medications for blood pressure control, and recommends finding way to consolidate multiple medications into a single pill.
What this means for you
Under the new definition, nearly one-half of the entire United States adult population has high blood pressure. For adults under the age of 45, the impact is even more significant. In men, the diagnosis of high blood pressure will triple under the new guidelines, while in women it will double.
Researchers involved in developing the new recommendations emphasize that their concern is based on raising awareness of risk. Medical research shows that adults with a blood pressure of 140/90 have already doubled their risk of cardiovascular complications compared to people with a normal blood pressure.
Based on these new guidelines, the standard of care requires the diagnosis of hypertension to be based on an average of two or more carefully recorded readings obtained on two or more separate occasions. This is significant because there is a well-documented phenomenon called white-coat hypertension. This term recognizes that around 15-25% of patients will have an elevated blood pressure by merely being in a doctor’s office or seeing a doctor.
Doctors should give careful attention to the matter in which they measure blood pressure, to minimize the effect of the white-coat issues. In addition, by averaging two or more blood pressure readings measured over a period of time, doctors can avoid a faulty diagnosis based on one fluke or outlier reading.
Of course, physicians and other healthcare providers have the best training for measuring blood pressure, but the task force recommends measurements at home or outside the doctor’s office for confirming the diagnosis of hypertension. If you regularly measure your blood pressure at home and keep a journal of the readings, you can provide this information to your doctor for confirmation of the diagnosis, as well as adjusting the levels of blood pressure-lowering medications.
We are here to help
If you or someone you care for has been seriously injured as a result of a physician or healthcare provider misdiagnosing or mistreating high blood pressure, call the experienced medical malpractice lawyers at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is a former hospital administrator and a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. In 2017, he was recognized as one of Houston’s top lawyers by both Houstonia and H Texas magazines. He is a frequent speaker and writer on health care and medical negligence topics, was a past editor-in-chief of The Houston Lawyer magazine, and is a current member of the editorial board of the Texas Bar Journal.