The changes were motivated largely by data from a federal study published in 2015 called SPRINT [the Systolic Blood Pressure Intervention Trial], which showed that lowering blood pressure well below 140 over 90 had substantial benefits, including for older people.

There are two main messages: First, people at a higher risk of a future heart attack or stroke should be treated more intensively to achieve a blood pressure below 130 over 80. In particular, older people should be treated just as intensively as younger people. Second, the new guidelines define normal blood pressure as less than 120 over 80 or less. While medication should not necessarily be used to achieve this blood pressure, other nondrug strategies should be employed to lower blood pressure toward this level.

It is estimated that under these new guidelines, 103 million Americans have high blood pressure, up from 72 million under the previous standard.

Nearly half of all American adults, and nearly 80 percent of those aged 65 and older, will find that they qualify for blood pressure medication and will need to take steps to reduce their blood pressure.

High blood pressure increases the risk of having a heart attack or stroke, as well as several other diseases affecting the arteries in the body. The impact of blood pressure is strongest at very high levels of blood pressure (greater than 180 over 110) but is still significant at any level above 120 over 80. For someone in their 50s, a blood pressure of 160 over 100 increases the risk of having a heart attack or stroke by 50 percent compared with a blood pressure of 120 over 80.

While medications that lower blood pressure are a key tool, many nondrug strategies are also useful, but often neglected. Lifestyle changes are not easy, but should be central to how we approach high blood pressure. Changes in physical activity, diet, sleep and weight not only lower blood pressure with few side effects, but also favorably impact the risk of other important outcomes such as cancer and cognitive decline. Many drugs work more effectively when combined with lifestyle changes. The new guidelines hinge on people at higher risk for future bad events — like heart attacks and strokes — being treated more intensively.  This requires being more aggressive about lifestyle changes, as well as being more willing to prescribe multiple medications for blood pressure. A good first step for many people is to begin a routine of walking each day with a gradual increase in the distance covered.

Increasing physical activity is a potent strategy for reducing the risk of multiple chronic diseases, yet in the United States, most of the population is sedentary or near-sedentary.

In many ways, this is a failure of our health care system. This system is really a “sick care” system that is organized around dealing with acute, short-term problems rather than issues that need continued attention over time.

Physicians similarly want quick solutions and often don’t have the training needed to provide persuasive advice about lifestyle change. We live in environments that promote obesity and that make healthy choices difficult. Surrounded by advertising promises and hype, consumers themselves want an easy fix to their problems, rather than the hard work required to live a healthier lifestyle. In the end, however, the substantial benefits can make the hard work worth it.

The new blood pressure guidelines stress that people at higher risk of future harmful events should be treated more aggressively. More widespread use of this concept would lead to more effective and less costly care for many conditions. In fact, we already use this risk-based care approach in other clinical situations.

For example, treatment recommendations for high cholesterol, asthma and reduced bone mineral density are based on future risk. We could easily broaden this approach to how we treat other conditions, such as diabetes and bronchitis. The downside, of course, is that we need to give up the simplicity of a one-size-fits-all approach.

In addition, if we understand that our true goal is to reduce future risk, this implies that we need to treat all of the factors that contribute to high risk. For example, if we are really “treating” the future risk of stroke and heart attack, we should emphasize lifestyle changes and simultaneously consider blood pressure medicines, statins and aspirin.