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Do the New Hypertension Guidelines Set the Bar too Low?

Heart impacted by high blood pressure medicationThe guidelines for the Detection, Evaluation and Treatment of High Blood Pressure have been updated to provide more leniency when treating this medical condition in patients over 60 years old. These new guidelines will affect the treatment given to millions of people, but is it for the better?

(Quick Fact: February is American Heart Month which means more people should be thinking about what they could do to reduce their blood pressure and improve their heart health.)

Doctors are now recommended to treat hypertension (high blood pressure) in older patients if their blood pressure levels are above 150/90. The standard for this age group had been 140/90 for many years.

Several cardiological specialists are not too pleased with these new hypertension guidelines. Some theorize that it’ll let some physicians take the treatment of high blood pressure less seriously. Others argue that the evidence on which these guidelines are based is not at all conclusive.

What Spurred On These Hypertension Guideline Changes

The Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (JNC8) looked at the results of several large-scale hypertension clinical trials that tested the effects of treatment vs. a placebo on the risk of suffering a cardiovascular complication.

These research studies provide very reliable results, but critics point out that study participants were only followed for 3 to 5 years. They argue that this period of time is not extensive enough to provide the basis for such a significant change in hypertension treatment guidelines. In most clinical settings, researchers are looking at time frame closer to a decade in order to get a full understanding of treatment effects.

These hypertension specialists say that it would take a very different type of study to build a concrete argument against treating mild cases of high blood pressure. A clinical study that could accurately show the benefit of lowering systolic pressure by 10 mm would need:

  • Participants that are randomly assigned to two separate levels of treatment
  • Researchers would need to monitor their health for at least 10 years

This type of high blood pressure study would be difficult to conduct accurately and are not likely to be given the green light.

Ensuring We Address Hypertension Adequately

Research has demonstrated that this medical condition can lead to several complications later in life, including:

 

Some specialists believe that treating high blood pressure in middle aged patients can reduce the odds of developing these issues in the long-run. Likewise, they don’t see much reason to starting treatment in older patients once these complications have begun to manifest.

There has been evidence to suggest that using medication to keep blood pressure levels under 160 is good for patients over 80. But there isn’t research to suggest that keeping them under 140 is beneficial. Since the optimal blood pressure can fluctuate between patients, there is not a strong incentive to keeping an 80 year old’s systolic pressure under 140.

Over-Treating People with High Blood Pressure

While the debate over these new hypertension guidelines is unlikely to ease very soon, most specialists will concede that the over-treatment of high blood pressure is a problem that needs to be addressed. There are several reasons that could explain this:

  • Patients are taking medications that aren’t addressing the root cause of their condition
  • White coat hypertension – situations when a person’s blood pressure elevates while at the doctor
  • Inaccurate blood pressure measurements

If you are at risk for high blood pressure, you’ll want to talk to your primary physician about these new guidelines as soon as possible. It’s important to be knowledgeable even if you’re not 100 percent in agreement with the latest recommendations.

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