Nearly Half of American Adults Have Heart Disease

Under current guidelines, roughly 100 million adults are considered hypertensive.

Nearly half of all adults in the United States—more than 121.5 million people—have some form of heart disease, according to a January 2019 report from the American Heart Association (AHA).

Every year since 1958, the AHA has compiled the most current data from the U.S. National Institutes of Health related to heart disease, stroke and associated risk factors, such as smoking, exercise, diet, cholesterol levels and weight.

The latest report revealed that as of 2016, 48 percent of U.S. adults had heart disease, including coronary heart disease, heart failure, hypertension and stroke. Heart disease remains the leading cause of death among Americans, the AHA found.

It’s important to understand, however, that the starting rise in heart disease is largely driven by changes in the way high blood pressure is defined.

Prevalence of high blood pressure
In November 2017, for the first time in 14 years, the AHA changed its blood pressure guidelines. These guidelines lowered the number for what’s considered high blood pressure, also called hypertension.

Blood pressure is depicted as a fraction, with a larger number on top and a smaller number on the bottom, separated by a slash. The top number is systolic blood pressure, which measures the pressure inside the arteries when the heart contracts or beats. The bottom number, diastolic blood pressure, measures the pressure in the arteries at rest, between heartbeats.

The guidelines for what’s considered normal blood pressure haven’t changed—that is, a reading of less than 120 mm Hg (millimeters of mercury) systolic and less than 80 mm Hg diastolic. But the current guidelines now define hypertension as a reading above 130 mm Hg systolic or 80 mm Hg diastolic. This is a change from the old definition of hypertension, which was 140/90 and higher.

Under this revised threshold, 46 percent of adults have high blood pressure—up from 32 percent under the previous guidelines. Excluding high blood pressure, the 2019 AHA report found that 9 percent of U.S. adults had heart disease as of 2016.

A May 2018 study in JAMA Cardiology, which also relied on data from the National Health and Nutrition Examination Survey as well as clinical trials and large cohort studies (studies that monitor people’s exposure to certain variables over time to find clues about possible causes of disease), also estimated that the number of hypertensive adults in the U.S. rose by 31 million under the updated guidelines. Meanwhile, the number of those for whom blood pressure-lowering treatment is recommended rose by 11 million. Despite these increases, the study found that less than one-third of people who are recommended medication are successfully being treated for hypertension.

Why you need to know your numbers
It’s in your best interest to know your numbers because high blood pressure can lead to a host of problems, such as artery damage, stroke, heart attack and even kidney and eye damage.

When blood pressure is high, your heart is working harder to pump blood through narrowing arteries. Given enough time pumping against high resistance, the heart will hypertrophy or grow bigger. This can lead to impaired blood flow, arrhythmia and cardiac arrest.

The current guidelines also eliminate the category of prehypertension, once defined as a blood pressure reading between 120 and 139 systolic or 80 to 89 diastolic. Now, the guidelines list:

Elevated: Systolic between 120 and 129 and diastolic less than 80
Stage 1: Systolic between 130 and 139 or diastolic between 80 and 89
Stage 2: Systolic at least 140 or diastolic at least 90—previously classified as stage 1

If your reading shows systolic blood pressure above 180 or diastolic above 120, this is considered a hypertensive crisis and you should seek prompt medical care.

Research suggests complications can arise before blood pressure reaches 140/90. These changes necessitate early intervention to prevent any further increase in blood pressure levels and to reduce the likelihood of hypertension-related complications, like stroke, vision loss and heart attack.

Tools of the trade: How to measure your blood pressure
Why is blood pressure measured in millimeters of mercury (mm Hg)? To understand the answer, take a closer look at the blood pressure cuff your nurse or doctor puts around your arm. The cuff is called a sphygmomanometer and, even today, many contain mercury to measure barometric pressure in the arteries.

The cuff is inflated to squeeze the artery and prevent blood from flowing, then the air is released. When the blood starts flowing again, the doctor or nurse will look at the pressure reading and determine the systolic blood pressure, or the pressure during the heartbeat. When the pulse can no longer be heard, that’s the diastolic pressure, or the pressure between beats.

Doctors typically check blood pressure at least once more after a reading comes back high.  Many people’s readings are higher in the doctor’s office than they are at home because doctors make them nervous; it’s a phenomenon known as white coat hypertension.

Talking while your blood pressure is being monitored or having a full bladder can also throw the reading off. Sometimes someone can have high blood pressure in one arm and not the other due to a problem with their blood vessels.

Your physician may want you to get a device to monitor your blood pressure at home. Look for a device that takes measurements from the upper arm and can be used on both arms. It’s a good idea to bring the device to your healthcare provider’s office to make sure it works correctly, and you know how to use it properly.

What you can do about high blood pressure

There is no cure for high blood pressure, but a combination of lifestyle modifications and medication can help manage hypertension and reduce your risk of complications. Your doctor is most adept to guide you through the changes you should be making, which might include:

  • Quitting smoking
  • Limiting salt intake
  • Scaling back alcohol consumption
  • Eating a well-balanced diet
  • Upping daily physical activity
  • Maintaining healthy weight
  • Sticking to your medication schedule

Find out how to check your numbers and lower your hypertension risk.

Medically reviewed in November 2019.

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