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Blood Pressure Guidelines Just Changed — And Millions Are Now Considered High | Dr. Mandell

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The American Heart Association and American College of Cardiology recently updated their blood pressure guidelines, and millions of people are now considered “high” — even if their systolic number is only 120–129. But does that really mean you’re unhealthy? Let’s break down what these new rules mean, why treating the number alone can be dangerous, and what really drives high blood pressure in the first place.

High blood pressure isn’t just about salt or one office reading. The physiology shows that insulin resistance plays a major role. Elevated insulin levels increase sympathetic nervous system activity, raise vascular tone, and cause sodium retention in the kidneys. This leads to stiffer arteries, higher blood volume, and more strain on the heart and brain. Without addressing insulin resistance, simply chasing lower numbers with medication can leave patients overtreated, dizzy, and at risk for falls — especially in older adults.

✅ PubMed Research References

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. Journal of the American College of Cardiology. 2018;71(19):e127–e248. PMID: 29133356.

De Boer IH, Bangalore S, Benetos A, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273–1284. PMID: 28830958.

Seravalle G, Grassi G. Sympathetic Nervous System, Hypertension, Obesity and Insulin Resistance. Current Hypertension Reports. 2017;19(9):77. PMID: 28780657.

Oparil S, Zaman MA, Calhoun DA. Pathogenesis of Hypertension. Annals of Internal Medicine. 2003;139(9):761–776. PMID: 14597461.

Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial (SPRINT). JAMA. 2016;315(24):2673–2682. PMID: 27195814.

Ricci F, Fedorowski A, Radico F, et al. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. Journal of the American College of Cardiology. 2015;66(7):848–860. PMID: 26271077.

What matters most is your average blood pressure over time, not one snapshot. And more importantly, fixing the root causes — improving insulin sensitivity, reducing processed carbs and sugars, sleeping better, lowering stress, exercising, and eating potassium-rich whole foods — often lowers blood pressure naturally. Medication can help when necessary, but it should never be a substitute for solving the real problem.

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Medical
Tags
blood pressure guidelines, new blood pressure rules, high blood pressure explained
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