Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
When it comes to the possible causes of high blood pressure (hypertension), some are within our control (We call these modifiable risk factors) and some are not (We call them non-modifiable risk factors). Among the non-modifiable risk factors is age. What’s considered a normal blood pressure for someone over 80 is significantly higher than what’s considered healthy for an 18-year-old.
If you’re keeping track of your blood pressure by monitoring it at home or during doctor visits, it’s reasonable to wonder whether you’re in the right range for your age. And since we also know that women and men have different risk profiles when it comes to hypertension, you may be looking for an authoritative chart showing age bands and acceptable blood pressure for men and women.
There are two problems with relying on such charts. The first is that, while a chart can give a general sense of where you should be, an ideal blood pressure is a highly individualized thing. You might have a very different genetic risk profile than your age and gender peers, for example, which could make your ideal blood pressure quite different from theirs.
The second problem is that the leading authorities on blood pressure ranges, the American Heart Association and the American College of Cardiology, stopped using age and gender categories in their guidelines in 2017. You can get a sense of “normal” through the chart below, based on data from the National Center for Health Statistics, but note that it reports average blood pressures in US adults, not ideal blood pressures. That’s an important distinction in a country in which we know hypertension is a very common problem.
Average US Blood Pressures
The 2017 changes to the American Heart Association’s and American College of Cardiology’s guidelines were based on a study called the Systolic Blood Pressure Intervention Trial (SPRINT), in which more than 9,000 adults aged 50 and older were studied for a three-year period. The patients had at least one risk factor for cardiovascular disease, and they all had systolic blood pressure readings (the “top number”) of 130 mmHg or higher. The primary aim of the study was to discover whether heart attacks, heart failure and strokes would be reduced if doctors aggressively treated patients to get their systolic pressure down to 120 mmHg or less instead of just the traditional target of 140 mmHg or lower. The SPRINT trial showed that, indeed, all three outcomes—heart attack, heart failure and stroke—were reduced by aiming for the lower number.
The results were sufficiently compelling as to warrant changing the guidelines. But in establishing new guidelines, healthcare experts are careful to base them closely on the evidence at hand. And because the SPRINT study had not divided its patients up by gender or age (they were all just 50 and older), the new guidelines make no distinctions based on those categories. Instead, the guidelines indicate that all adults should aim for blood pressure of 130/80 or better.
The new guidelines also changed the categories associated with certain blood pressures. They divided up what used to be a broad category known as “prehypertension,” which had been used to indicate systolic pressure of 120-139 mmHg and diastolic pressure (the “bottom number”) of 80-89 mmHg. According to the new guidelines, people with systolic pressure of 120-129 mmHg and diastolic pressure of less than 80 mmHg are said to have “elevated pressure,” while those with systolic pressure of 130-139 and diastolic pressure of 80-89 are considered as having Stage 1 hypertension.
The cutoff for Stage 2 hypertension is 140/90 mmHg. If your blood pressure is higher than 180/20, you’re considered to be in hypertensive crisis, a dangerous state requiring immediate medical attention.
2017 Blood Pressure Guidelines (American Heart Association, American College of Cardiology)
|Hypertension Stage 1
|Hypertension Stage 2
In establishing their guidelines, experts do not mean to suggest that falling just over or just under the threshold for a certain category decisively puts you in or out of danger. Instead, the guidelines are meant to provide physicians with a broad framework for assessing cardiovascular risks associated with blood pressures in certain ranges. Your doctor will work with you to understand your risks as an individual and to arrive at a good target blood pressure. Take your doctor’s suggestions rather than relying rigidly on this or any chart.
When the new guidelines came out, many people who had previously been told they had “prehypertension” landed in the new category of “Stage 1 Hypertension,” and their doctors urged them to get on antihypertension medications despite no change in their blood pressure, only to the labels attached to that blood pressure. But that makes sense, given that the research behind the new guidelines supports a more aggressive approach to blood pressure management. Getting blood pressure below 120/80 remains the best goal for all US adults. If you can do that through diet, exercise, good sleep habits and stress reduction, that’s wonderful. But if not, adding medications to those lifestyle changes just may be the key that gets your blood pressure back down into the normal range. Your doctor is your trusted partner in making that happen.