A change in what constitutes high blood pressure has led to a startling statistic: nearly half of all adults in the U.S. have some type of cardiovascular disease (CVD).

The 2017 American Heart Association/American College of Cardiology hypertension guidelines updated the definition of high blood pressure as a reading of 130/80 mm Hg, from the previous definition of 140/90 mm Hg. That revision translated into 48 percent of the adult population in the U.S. – or some 121.5 million people – having CVD, according to the American Heart Association’s (AHA) Heart and Stroke Statistics — 2019 Update, published in the Association’s journal Circulation. That’s a significant increase in previous years.

The leading cause of death

Cardiovascular disease remains the leading cause of death globally. After decades of a steady decline in the U.S., CVD deaths are on the rise (840,678 deaths in 2016 up from 836,546 in 2015), although worldwide, the number of people dying from CVD was lower in 2016 (17.6 million) than the previous year (17.9 million).

Overall, cardiovascular disease is comprised of coronary heart disease, heart failure, stroke and high blood pressure. Excluding high blood pressure, CVD prevalence among adults in the U.S. is 9 percent overall (24.3 million in 2016).

“As one of the most common and dangerous risk factors for heart disease and stroke, this overwhelming presence of high blood pressure can’t be dismissed from the equation in our fight against cardiovascular disease,” said Ivor J. Benjamin, M.D., volunteer president of the AHA and director of the Cardiovascular Center at the Medical College of Wisconsin in Milwaukee. “Research has shown that eliminating high blood pressure could have a larger impact on CVD deaths than the elimination of all other risk factors among women and all except smoking among men.”

Research shows approximately 80 percent of all cardiovascular disease can be prevented by controlling high blood pressure, diabetes and high cholesterol, along with adopting healthy lifestyle behaviors such as not smoking. The health behaviors such as eating a healthy diet, engaging in physical activity and maintaining a healthy weight could have the most impact as they contribute to multiple conditions.

Some of the most significant improvements in risk reduction are in the decline of smoking rates:

• Among children aged 12 to 19, 94 percent were nonsmokers in 2015 to 2016, up nearly 20 percentage points from the turn of the millennium (from 76 percent in 1999 to 2000);
• The percentage of adolescents (12–17 years old) who reported smoking in the past month dropped by two-thirds in just 14 years (declined from 13 percent in 2002 to 3.4 percent in 2016);
• 79 percent of adults were nonsmokers in 2015 to 2016, up from 73 percent in 1999 to 2000; and
• In the past 50 years, the number of adults who smoke has plummeted from 51 percent of males smoking in 1965 to 16.7 percent in 2015 and from 34 percent of females in 1965 to 13.6 percent in 2015 (age-adjusted rates).

More Americans are getting up and moving:

• More than half of students report participating in muscle-strengthening activities on three or more days per week (from 47.8 percent in1991 to 53.4 percent in 2015); and
• The prevalence of physical inactivity among adults has decreased by more than a third (from 40.2 percent in 2005 to 26.9 percent in 2016).

Yet, exercise alone may not be enough, as the 2015 to 2016 prevalence of obesity was 39.6 percent of US adults and 18.5 percent of youths, with 7.7 percent of adults and 5.6 percent of youth having severe obesity.

Sleep is a factor

A new chapter added to the statistical update looks at the importance of sleep in relation to cardiovascular and overall health. According to the update, the American Academy of Sleep Medicine and the Sleep Research Society recommend adults get at least seven or more hours of sleep per night to promote optimal health. The statistical update cites several recent studies on sleep: a report from the Centers for Disease Control and Prevention found 65.2 of people in the U.S. regularly sleep seven or more hours a night; and a meta-analysis of 43 studies found that too much or too little (more than eight hours or less than seven hours per night) were associated with a greater risk of death from all causes.

Other new features of the 2019 update include more information on the impact of social determinant of health, more evidence-based approaches to changing behaviors and an expanded focus on the global burden of CVD. 

In a commentary posted on the AHA’s Centers for Health Metrics and Evaluation website, the Chief Science and Medical Officer of the AHA, Mariell Jessup, M.D., explained why these annual updates are not just an interesting compilation of facts, but an important tool in the organization’s mission.

“We pour so much effort into our update each year because we believe in the transformative power of continuously and systematically collecting, analyzing and interpreting these important data,” Jessup wrote. “They hold us accountable and help us chart our progress and determine if and how we need to adjust our efforts.”