The new "normal" blood pressure: what are the implications for family medicine?

BACKGROUND In 2003, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure redefined normal blood pressure (BP) as less than 120/80 mm Hg and added the category of prehypertension, recommending that such patients receive counseling on lifestyle modifications. Based on population data, 41.8% of US adults have normal BP, 31% have prehypertension, and the remainder has hypertension. These percentages may not reflect the proportions seen in family medicine practices. The purposes of this study were to describe the proportion of adults in a family medicine practice with normal BP and the proportions with prehypertension and hypertension and to examine associations with having normal BP. METHODS Records of 633 nonpregnant adults from a large family medicine clinic were reviewed for demographic and BP information. Proportions of subjects in each BP category (normal, prehypertension, or hypertension) were determined. Characteristics associated with normal BP were examined using chi(2) tests and logistic regression. RESULTS Nearly 80% of adults in this population had prehypertension or hypertension. Subjects more likely to have normal BP were young, female, white, and not overweight/obese. Almost 60% of subjects had documented hypertension, were receiving antihypertensive medications, or had a BP on the day of visit > or = 140/90 mm Hg. Over 20% had prehypertension. CONCLUSION The proportion of adult family medicine patients with normal BP is low. Counseling 20% of adult patients about prehypertension while continuing to strive to improve BP control for the 60% of patients with hypertension could pose a new challenge to clinicians working in family medicine offices.