New Guidelines Ease Blood Pressure Target

Hypertension therapy may begin at higher blood pressure levels than current guidelines suggest

(RxWiki News) If you take medication to treat high blood pressure, you may want to reevaluate your treatment. New guidelines recommend that blood pressure targets for those over 60 years old be raised.

For years, the American Heart Association and other health groups have considered 140/90 mm Hg and above to be high blood pressure for all ages. If those readings are sustained over time, doctors typically put patients on a treatment program, including blood pressure medications.

After five years of review, a group of 17 academics have released recommendations suggesting that individuals over 60 years old not take blood pressure medication unless their blood pressure goes over 150/90.

"Consult a doctor about taking high blood pressure medication."

Suzanne Oparil, MD, University of Alabama at Birmingham professor of medicine and director of the vascular biology and hypertensive program in UAB’s School of Medicine, co-chaired the panel, which was originally formed by the U.S. National Heart, Lung, and Blood Institute in 2008 to update blood pressure guidelines.

Dr. Oparil and her colleagues based their recommendations on evidence gathered from randomized clinical trials for the management of high blood pressure. They stress that the guidelines are for doctors to treat their patients, and patients should not make their own treatment decisions based on them.

Researchers found that people ages 60 and older who take medications to bring their blood pressure to under 150/90 reduce the risk of having stroke, heart attack, or heart disease.

The scientists, however, found no evidence that lowering blood pressure offers further additional health benefits for people in this age range, and that some patients may currently be taking medications that are not helping them reduce their risk of stroke, heart attack, or heart disease.

“Taking unnecessary medication may increase the burdens on patients, resulting in additional time in the doctor’s office and expensive testing,” said Dr. Oparil in a press release.

The panel maintained that a blood pressure goal of 140/90 or less should still be the goal of people under the age of 60 and for those who have diabetes or kidney disease.

The new guidelines could affect millions of Americans who are over 60 and taking medication for blood pressure that is between 140/90 and 149/90.

In a blood pressure reading, the top number is called the systolic, and it measures the pressure in the arteries when the heart beats (when the heart muscle contracts). The bottom number is called the diastolic, and it measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).

The panel also recommends that healthcare providers regularly evaluate blood pressure, encourage lifestyle and adherence interventions, and adjust treatment until goal blood pressure is attained and maintained.

“The potential benefits of a healthy diet, weight control, and regular exercise for all persons with hypertension cannot be overemphasized,” Dr. Oparil said in a press release. “These lifestyle treatments have the potential to improve blood pressure and even reduce medication needs.”

Investigators highlighted four different blood pressure medications for providing the highest benefit — diuretics, calcium channel blockers (CCBs), angiotensin converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs).

Dr. Oparil underscored that African Americans seem to respond better to treatment with CCBs and diuretics than the ARBs or ACEIs.

Sarah Samaan, MD, cardiologist and physician partner at the Baylor Heart Hospital in Plano, Texas, told dailyRX News, “I think that these new guidelines will help physicians make decisions about when and how much to treat their patients with hypertension. For example, some experts have advised that the ‘perfect’ blood pressure is somewhere around 115/70. However, blood pressure typically fluctuates 20 percent or more over the course of a normal day. For many people, treating to this low goal also means that the blood pressure can sometimes get too low. Especially in people over 60, excessively low blood pressure can be a serious problem, since it can lead to dizziness and falls.”

Dr. Samann added that it can be difficult to achieve some low blood pressure targets with only one medication, so often multiple drugs are prescribed.

“This can lead to drug interactions, more side effects, and of course higher costs,” she said. “This is not to say that blood pressure should not be aggressively treated. Hypertension is one of the leading causes of heart disease, stroke, and kidney failure. It can also contribute to dementia. It's also important to realize that a heart smart diet, regular exercise, and maintaining a healthy body weight can be just as powerful as a prescription drug.”

The report was published in the Journal of the American Medical Association in December.

Review Date: 
December 21, 2013