New Blood Pressure Guidelines May Decrease Medication Use

Target blood pressure lowered with new guidelines

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Most physicians refer to well-established guidelines that dictate when to start treatment for high blood pressure. Even a small change in target blood pressure guidelines can have a significant effect on the way blood pressure treatment is considered.

A recent study found that the new guidelines on blood pressure control may decrease the amount of high blood pressure patients needing medication.

However, the researchers suggested that high blood pressure patients should pay close attention to keeping their blood pressure under control. They concluded that the majority of Americans were and are under-treated for high blood pressure under both the new and old guidelines, putting them at risk for stroke and heart attacks.

"Discuss the new blood pressure goals with your doctor."

The lead author of this study was Anne Marie Navar-Boggan, MD, PhD, from the Division of Cardiology at Duke University Medical Center in Durham, North Carolina.

The study included 16,372 adults who took the National Health and Nutrition Examination Survey between 2005 and 2010.

Under the previous guidelines the target blood pressure for adults was set at 140/90 mm Hg or lower. The new 2014 guidelines increased the target blood pressure to 150/90 mm Hg or lower. If a patient's blood pressure is above the target blood pressure, they are considered "treatment-eligible."

The target blood pressure in the old guidelines for adults with chronic kidney disease and diabetes was 130/80 mm Hg or lower. The new guidelines increased the target blood pressure for this population to 140/90 mm Hg or lower.

The researchers measured the participants' blood pressure, and these participants reported on their use of blood pressure medications.

Treatment-eligible high blood pressure was defined as having a blood pressure above the target set by each of the guidelines, or having goal blood pressure and reporting blood pressure treatment.

The findings showed that fewer participants between the ages of 18 and 59 years old were treatment-eligible under new guidelines compared to the the previous guidelines — decreasing from 20 percent of the participants to 19 percent under the new 2014 guidelines.

Among the participants aged 60 years and older, 69 percent were treatment-eligible under the previous guidelines and only 61 percent were eligible under the 2014 guidelines.

Under the previous guidelines, 41 percent of adults between the ages of 18 and 59 were considered to have met their goal blood pressure, compared with 48 percent under the 2014 guidelines.

The researchers found that the amount of adults aged 60 years and older who were considered to have met their goal blood pressure increased from 40 percent under the previous guidelines to 66 percent under the new guidelines.

Overall, 2 percent of American adults between the ages of 18 and 59 years old and 28 percent of adults aged 60 years and older were taking blood pressure-lowering medication and meeting the target blood pressure under the previous guidelines.

In addition, 13.5 million adults would no longer be considered as having poorly controlled blood pressure, and instead would be considered adequately managed. This includes 5.8 million adults who would no longer need blood pressure medication if the new guidelines were applied.

However, although these guidelines provide evidence-based recommendations for the management of high blood pressure and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

"This study reinforces how many Americans with hypertension fall into the treatment 'gray zone' where we don't know how aggressive to treat and where we urgently need to conduct more research," said Eric D. Peterson, MD, co-author of this study.

This research had a few limitations. First, blood pressure was measured according to National Health and Nutrition Examination Survey requirements and they may be inaccurate. Second, medication use was self-reported.

Third, these guidelines may be different for people with diabetes or kidney disease.

Lastly, five out of the 17 authors of the new guidelines maintained that the blood pressure goals sent by the previous guidelines shouldn't change.

This study was published on March 29 in JAMA.

The Duke Research Institute, M. Jean de Granpre and Louis and Sylvia Vogel provided funding.

Review Date: 
March 29, 2014
Last Updated:
April 1, 2014