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December 19, 2013

Blood Pressure Guidelines Revamped

by VOA News

For the first time in decades, experts have raised the threshold for what is considered dangerously high blood pressure for people aged 60 and over. As a result, patients may be prescribed fewer drugs to treat hypertension.

High blood pressure, or hypertension, is the most common condition seen in primary care and leads to heart attacks, kidney failure, and death if not detected early and treated appropriately.

A government-appointed panel that made the recommendations stressed that they are not changing the definition of high blood pressure, which currently is 140 over 90 but that for adults aged 60 and older, they are recommending a higher treatment threshold, prescribing medicine only when blood pressure levels reach 150 over 90 or higher.

In older people too much high blood pressure medication can cause fainting and falls, the panel said. Furthermore, medication to treat high blood pressure could react negatively with other medications.

For younger patients, treatment recommendations remain unchanged.

"This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults,” the study says.

According to Paul James, professor and head of family medicine at University of Iowa Hospitals and Clinics and co-chair of the panel making the recommendations, past guidelines from the last several decades “have been based on consensus by experts.”

“These  [recommendations] were based on scientific evidence from randomized controlled trials,” he said. “Expert opinion was used only in the absence of scientific evidence.”

The panel reviewed numerous past studies from January 1, 1966 to December 31, 2009, as well as major, eligible studies that took place between December 2009 and August 2013.

The review focused on adults age 18 and older with hypertension and included studies involving diabetes, coronary artery disease, peripheral artery disease, heart failure, previous stroke, chronic kidney disease, proteinuria, older adults, men and women, racial and ethnic groups, and smokers.

Panelists also looked at methods of controlling high blood pressure, including what medication should be started in patients with hypertension; what blood pressure goal should patients achieve to know they are enjoying proven health benefits from their medication and what are the best medication choices to reach the goal blood pressure.

The recommendations are not without controversy.

According to the Associated Press, the American Heart Association is raising concerns about the new recommendations, saying that many of the studies reviewed didn't last long enough to reveal dangers of undertreated high blood pressure in older patients.

The guidelines were published in the Journal of the American Medical Association.