“New” but NOT improved

Why the AHA’s blood pressure guidelines put you at risk—and what you should do instead 

You’d better buckle up, because here we go again…

Back in December’s newsletter, I shared the good, the bad, and the ugly of the new “official” blood pressure guidelines for diabetics. (You can check out my archives via www.DrPescatore.com.) Now, in a shot heard round the world, another set of U.S. hypertension guidelines has also been released. This time, from the American College of Cardiology (ACC) and the American Heart Association (AHA).1

Of course, not everyone is happy about these recommendations. Including myself and a bunch of European experts who can see right through this ruse for what it is—a shameless attempt to justify overmedicating the public.

But the American medical community and Big Pharma are quite pleased with themselves. And it’s not hard to see why.

Half of all Americans are now officially hypertensive

For one thing, the new guidelines lower the threshold for hypertension to a reading of 130/80—down from 140/90—for everyone. Obviously, this means a lot more people than usual will be diagnosed with high blood pressure. And accordingly, more patients will be eligible for drug therapy.

Are you surprised by this? I’m certainly not. But just you wait, because there’s plenty more where that came from…

With this lower threshold comes a new designation called “stage 1 hypertension.” Patients with top numbers between 130 and 139 mm Hg, or with bottom numbers between 80 and 89 mm Hg, fall into this category. Whereas previously, they’d be classified as having prehypertension.

Patients with systolic pressure above 140 mm Hg, or diastolic pressure above 90 mm Hg, will now be diagnosed as having “stage 2 hypertension.”

These new guidelines also prescribe drug therapy for anyone with stage 1 hypertension considered to be at high risk of atherosclerosis. (In this case, that’s anyone with a 10-year risk over 10 percent—including patients with diabetes or kidney disease, or anyone over the age of 65.)

Another change: The guidelines indicate that treatment should always include at least two drugs—and that’s just to start.

The only thing remotely sane about these new guidelines is the emphasis on more accurate blood pressure readings. Though doctors should have already been as thorough as possible—relying on multiple readings over several visits, as well as readings out of the office—before even thinking about prescribing medication in the first place.

The bottom line is that we are now looking at a situation where half—yes, half—of the American population will be officially labeled as having high blood pressure. And with lower treatment targets in place for people of all ages, it’s not just these newly diagnosed patients who are facing the prospect of overmedication.

Treatment by the numbers puts older patients at risk

Aside from the unnecessary anxiety this new “normal” is likely to cause, the potential for collateral damage is crystal clear. Especially since elderly patients—who, according to plenty of solid research, should be shooting for systolic numbers under 150 mm Hg—will now have their blood pressure target pushed down to dangerous new lows.

That’s because these guidelines relied heavily on the results of the National Institutes of Health’s incredibly flawed SPRINT trial. This study proposed that all patients aim for systolic blood pressure below 120—no matter how many drugs it takes to get there.2

That could mean three or more prescriptions for many hypertension patients. Needless to say, that suggestion has been met with some skepticism in the global medical community. And for good reason.

As I explained a couple of months ago in my Reality Health Check e-letter (“New research exposes SPRINT’s fatal flaw”), a team of Irish researchers recently found that falls and blackouts were five times higher in patients with systolic pressure so low. And that sudden blood pressure drops upon standing nearly doubled.3

These are hardly acceptable risks. Especially considering that studies larger than SPRINT show no significant differences in cardiovascular events and mortality rates with systolic pressures below 120.

In fact, treatment this aggressive raises rates of low blood pressure, electrolyte imbalance, and elevated creatinine… all of which pave the way to kidney damage.

This risk was reason enough for the American Diabetes Association to disregard SPRINT’s conclusions when forming their blood pressure guidelines (which was a rare moment of clarity for them). But apparently, the AHA is perfectly okay with cracking a few eggs to make their heavily medicated omelet.

This is unfortunately typical of cardiologists. They care about one organ and one organ only—your heart. Granted, it’s an important one. But should it really come at the expense of the rest of your body? Particularly when there’s no proof that pushing blood pressure so low is even beneficial?

As physicians, we all pledge to “first, do no harm.”

Yet here we have “experts” who insist upon treatment by the numbers, without regard for how the patient will feel on this amount of medication. While Big Pharma maintains its role as the true beneficiary of a gift that just keeps on giving—drugs, drugs, and more drugs.

Smart medicine isn’t one-size-fits-all

Ultimately, these guidelines pose the same threat that overly aggressive cancer screening does. Sure, you’ll identify more people who might benefit from blood pressure intervention. But at the same time, you’ll be setting up a whole lot of other patients for gross overtreatment.

And if I’ve said it once, I’ve said it at least a thousand times—these drugs are not risk-free. Beta blockers can cause breathing problems and weight gain. Calcium channel blockers have been linked to breast cancer. And diuretics can deplete all the healthy minerals in your body.

Tell me again why forcing doctors to hand out these prescriptions even more liberally than they already do is a good idea?

Yet the AHA and the ACC don’t even acknowledge the kind of harm their new intensive treatment strategy could cause. Which is exactly what you might expect from people who would put statins in our water supply if they could…

To be clear, I’m not saying you should ignore high blood pressure. That would be ridiculous—and I’ve written many articles about how dangerous untreated hypertension can be. But I don’t think there’s a “magic number” that everyone should be aiming for. And the idea that it should be achieved at any cost is even more ridiculous.

One-size-fits-all just doesn’t apply when it comes to health issues—and that’s precisely where all of these guidelines fall short. A better approach would be to focus on lowering high blood pressure, safely and significantly, without a specific target in mind.

It’s the same sort of advice I give to my patients who are overweight. Because my practice isn’t built around numbers. It’s built around people who are trying to get healthier.

I recommend these to any patient who wants to rein in their blood pressure or maintain healthy levels.


Six all-natural supplements for healthy blood pressure 

Magnesium orotate. 
Regulating blood pressure is one of magnesium’s many roles in the body. And orotate is the most absorbable form. I recommend 60 mg per day.

Another amino acid I’ve found to be exceptionally helpful for regulating mood and stress. And, in turn, blood pressure. I generally recommend 400 mg each morning.

This is an amino acid and acts as a natural diuretic. But it doesn’t eliminate healthy minerals. Take 1,000 mg twice per day.

Pycnogenol helps keep collagen and elastin in the blood vessel walls healthy. I recommend 100 mg per day.

This amino acid has significant calming properties. And since stress is a major factor in hypertension, theanine is one of the most helpful supplements. I recommend 200 mg three to four times per day.

Probably the oldest blood pressure “medication” there is. It’s been used for centuries–and is just as effective today as it was hundreds of years ago. I recommend 300 mg three times per day.



  1. Whelton PK, et al. Hypertension. 2017 Nov 13
  2. SPRINT Research Group, et al. N Engl J Med. 2015 Nov 26;373(22):2103-16.
  3. Sexton DJ, et al. JAMA Intern Med. 2017 Sep 1;177(9):1385-1387.