Cardiology Society issues alert: 12x8 blood pressure is a cause for concern

For a long time, when measuring blood pressure, values ​​of 12/8 were considered normal—at most, borderline normal. However, a new guideline released at the 80th Brazilian Congress of Cardiology, held last Thursday, the 18th, challenged this reality.

The document, jointly developed by the Brazilian Society of Cardiology (SBC), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Hypertension (SBH), redefines diagnostic and prevention parameters. What was previously considered a safe level is now classified as pre-hypertension. The change aims to intensify the prevention of cardiovascular diseases, which remain the leading cause of death worldwide.

According to the new guidelines, values ​​between 120-139 mmHg (systolic) and/or 80-89 mmHg (diastolic) are now classified as prehypertension. The first approach should be lifestyle changes to reduce these numbers. If these measures are ineffective, medication may be considered.

• Pressure from 13×8 to 13.9×8.9: if, after three months, lifestyle changes are not enough to reverse the values, a prescription for medication will be indicated.

•Pressure from 14×9 (in two measurements): drug treatment must be started immediately.

Recommended changes include weight loss, reduced salt intake, increased potassium intake, regular physical activity, and adherence to the DASH eating model—which prioritizes fruits, vegetables, low-fat dairy, whole grains, lean meats, and nuts. At the same time, saturated fats, such as fatty meats and full-fat dairy, should be reduced, as well as refined grains and sugars.

This update follows a global trend: in 2024, the European Congress of Cardiology had already reclassified pressure 12 by 8, now considering it “high blood pressure”, a stage prior to the diagnosis of hypertension.

What the expert says

For cardiologist Fausto Stauffer, Fellow of the European Society of Cardiology (FESC), PhD in Medical Biochemistry from UFRJ and former president of SBC-DF, this change represents an important advance for prevention.

"I think this change is an excellent warning to the public. Those who don't make the necessary lifestyle changes inevitably have a high risk of developing hypertension, which is one of the main cardiovascular risk factors. This new criterion is also important for us physicians, because many still didn't value blood pressure levels between 120 and 139 systolic and 80 to 89 diastolic, considering them only 'borderline normal.' Now we have the support to classify these patients as pre-hypertensive," he explains.

“In fact, the 2024 European directive already adopts this position, calling this range 'high blood pressure', precisely with the aim of generating an alert for both the population and health professionals.”

Stauffer emphasizes that, in clinical practice, he has always guided patients with these pressure levels.

"I've always warned my patients about the importance of lifestyle changes to maintain healthy blood pressure levels, as well as controlling cholesterol, glucose, and weight. This type of guidance should be part of any healthcare professional's routine."

Reversal is still possible in prehypertension

One of the central points of the new guideline is to highlight that pre-hypertension can still be reversed without medication, as long as there is a commitment to healthy habits.

"There's a good chance that a pre-hypertensive person, by adopting lifestyle changes, will never become hypertensive. That's why it's so important to raise awareness: at this stage, it's still possible to prevent the progression of the disease through healthy habits alone," the cardiologist emphasizes.

However, he makes an important observation: “In some cases of pre-hypertension, especially when the cardiovascular risk is high and the levels are between 130 and 139 systolic, we can already indicate drug treatment.”

When hypertension is already established, the scenario changes.

"It's a chronic disease, usually idiopathic, silent, and without a specific cause. In these cases, we don't talk about a cure, but rather about control, which must be achieved through lifestyle changes combined with medication—whether monotherapy or in combination. The key is to achieve the goals and avoid falling into so-called therapeutic inertia," he explains.

“It is worth remembering that in about 5% of cases there is a secondary cause for hypertension, and in these patients, by treating the underlying cause, we can indeed reverse the condition.”

With the new guidelines, the number of people classified as at risk increases significantly, but Stauffer emphasizes that they were already at risk before — they just weren't identified that way.

"These patients were already at risk. It's important to remember that most people, both in Brazil and worldwide, die from cardiovascular disease, and hypertension is one of the most relevant and prevalent risk factors. What's changing now is how we view this risk: these people are now more clearly alerted."