A Spike in Blood Pressure: Guidelines


By Briana Schreckengost

While many people tend to put it off, it is recommended to schedule a yearly appointment with a physician to get a check up on your health. Illnesses that make us feel poorly, like the common cold, influenza, or an earache often send us to the doctor, but it is just as important to be evaluated when we are feeling healthy too.

Having a yearly assessment completed helps detect early signs and symptoms of common chronic problems, such as cardiovascular disease.  For instance, hypertension, or high blood pressure, affects approximately one third of American adults and is the primary reason for over 40 million doctor visits each year.1 Based on new updates to blood pressure guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC), many adults may be facing a new diagnosis of hypertension.

Normal blood pressure is defined as having a systolic pressure (SBP) of <120 mmHg and a diastolic pressure (DBP) of <80 mmHg.  Hypertension, or blood pressure above these values, is a serious condition that increases the risk of cardiovascular disease in the long term and is an ailment that should not be taken lightly.2 In fact, in the United States, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor and comes only second to cigarette smoking as a preventable cause of death for any reason.2 For these reasons, prevention, early detection, and treatment is important.

Under the previous clinical recommendations that were published in 2003, patients were classified into either prehypertension (SBP 120-139 or DBP 80-89 mmHg), stage I hypertension (SBP 140-159 or DBP 90-99 mmHg) or stage II hypertension (SBP 160 or 100 mmHg) depending on their level of blood pressure elevation.3 In the updated guidelines released in November of 2017 by the AHA/ACC, the prehypertension category was eliminated and the criteria for stage I and II hypertension were lowered. Stage I hypertension is now defined as SBP 130-139 (or DBP 80-89 mmHg) and stage II hypertension is defined as SBP 140 (or DBP 90 mmHg).2,3 With these new changes, it is expected that approximately 50% of American adults may meet criteria for diagnosis of high blood pressure in the near future.

These new guidelines were partially prompted by recent clinical trials in which the focus was on treating patients with elevated blood pressures in two different manners, one of which required more intensive pharmacologic treatment.3 Patients that received more intensive therapy had a reduced risk of an acute cardiovascular event or death.3 While patients in the group treated more aggressively were at a higher risk for side effects such as hypotension (low blood pressure) and syncope (fainting), the benefit of treatment at a lower threshold outweighed the risk of these side effects.3

With this being the first update in clinical guidance for hypertension to come about in nearly 15 years, the question on the minds of many is, “How will this affect me?”.  It is important to note that people are not suddenly sicker. The definition of what is or is not hypertension has just changed, therefore allowing us to start treating patients with a risk for future complications sooner and reduce the long-term cardiovascular risks. Often people cannot tell that their blood pressure is elevated without having it checked, so what is the best advice? Make appointments for yearly checkups and know your blood pressure numbers.  If you currently have hypertension, are newly diagnosed, or think you may be at risk, talk to your physician or pharmacist about lifestyle changes and medications you can use to reduce your future risk of complications.


  1. Centers for Disease Control and Prevention. National Center for Health Statistics: Hypertension. https://www.cdc.gov/nchs/fastats/hypertension.htm. Accessed January 26, 2018.
  2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017 Nov 13 [Epub ahead of print].
  3. American Heart Association. High blood pressure redefined for first time in 14 years: 130 is the new high. https://newsroom.heart.org/news/high-blood-pressure-redefined-for-first-time-in-14-years-130-is-the-new-high. Accessed January 19, 2018.
  4. SPRING Rearch Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-16.

This article was written by Briana Schreckengost, a student pharmacist at Duquesne University School of Pharmacy, and reviewed by her faculty advisor, Dr. Jordan Covvey.

Briana is currently fifth year pharmacy student and works as an intern at Childrens Hospital of Pittsburgh, UPMC. She holds leadership roles at Duquesne in the American Pharmacist Association (APhA) Academy of Student Pharmacists and the Pediatric Pharmacist Advocacy Group (PPAG) and is active in the Emerging Leaders Committee of the Juvenile Diabetes Research Foundation. After graduation, Briana would like to pursue a pediatric pharmacy residency and practice in a neonatal intensive care or cardiac intensive care setting.

Dr. Covvey is an Assistant Professor in Pharmacy Administration at the Duquesne University School of Pharmacy. She earned her Doctor of Pharmacy from the University of Kentucky in 2010, and then completed residency training at Virginia Commonwealth University Health System in 2011. She subsequently passed her board certification in pharmacotherapy (BCPS) and was selected as a recipient of a Fulbright grant to complete a Doctor of Philosophy at the University of Strathclyde Institute of Pharmacy and Biomedical Sciences in Scotland. She currently teaches in the public and global health curriculum for pharmacy students at Duquesne, and her research area is in the utilization of healthcare data, such as electronic medical records, for quality improvement in prescribing.