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Cardiologists Quarrel Over New Hypertension Guidelines

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Physicians rarely fight openly about the best ways to practice good medicine. That's because doctors tend to accept the recommendations put forth by their professional organizations.

All that changed over the last several weeks. New guidelines (released on December 18 in JAMA) for treating people with high blood pressure have pitted the expert panel that created the revisions against cardiologists at the American Heart Association (AHA) and the American College of Cardiology (ACC).

In a nutshell, the Eighth Joint National Committee's (JNC 8) recommendations for managing hypertension relaxes the targets established more than a decade earlier by the JNC 7. Instead of requiring doctors to treat everyone over the age of 60 if their blood pressure is greater than 140/90, the new guidelines say the target is 150/90 or less. That means that millions of people may no longer need to take pills if their systolic blood pressure (the upper number) is under 150.

This has made some cardiologists furious. They want to keep the old target at 140 or less for everyone, regardless of a patient's age.

The furor over the new hypertension guidelines follows an equally divisive set of guidelines issued a few weeks earlier by the AHA and the ACC for cholesterol control with statins. Dr. Steve Nissen, Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, said on our radio show earlier this month that it was an error to create a CV Risk Calculator that puts so many more people on statins without first vetting it publicly: "I think it was a strategic mistake and it will mean that the guidelines will largely be ignored by the medical community."

The American College of Cardiology and the American Heart Association have taken a very aggressive treatment approach to both hypertension and heart disease, regardless of the evidence. Their experts want more people on statins and more people taking blood pressure medicines. But the sand is shifting beneath them.

The experts who eased the standards for people over 60 spent five years combing the medical literature before releasing their new recommendations. If anything, they may not have relaxed the targets enough.

On August 15, 2012, the Cochrane Collaboration released a report titled "Benefits of Antihypertensive Drugs for Mild Hypertension Are Unclear." This panel of experts reviewed all the available studies and concluded:

"Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs [randomized controlled trials]. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms."

 You can read more about the Cochrane Collaboration publication at this link.

Let's get one thing straight. Lower blood pressure is better than higher blood pressure when it comes to good health. But there are surprisingly few good studies demonstrating that medications make a difference for people in the mild to moderate range. (Meds do save lives for those with significant hypertension.)

But drugs have side effects. If a medicine makes an older person dizzy, that can lead to a fall and a broken hip. This can lead to permanent disability or death. Here is a link to more information about this complication of blood pressure medications.

What is the bottom line on the new guidelines for hypertension? First and foremost come lifestyle changes. There is solid evidence that exercise and weight loss can help bring blood pressure down. So can the foods you eat. The DASH (Dietary Approaches to Stop Hypertension) diet has been proven to help lower blood pressure. And vegetables like beets or teas made with hibiscus can also help control hypertension. Here is a link to more information about natural ways to mange high blood pressure with:

Hibiscus

Beets

Grapefruit

Chocolate & more Chocolate

We think the new hypertension guidelines are a step in the right direction. Putting the brakes on "disease creep" where the bar keeps being lowered to the point that everyone is diagnosed with something, is not doing the American public any favors. We think common sense, lifestyle changes and sensible use of medications is the best way forward. 

We welcome your thoughts on the new guidelines below in the comment section.

 

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17 Comments

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Very interesting. I wanted to get any follow-up comments, so I had to leave some kind of message!! Sorry

I am 84 years old. My systolic blood pressure runs from 140's to 170's at home, with the diastolic always being 80. In a doctor's office it can reach 190's. Mainstream doctors have tried me on multiple medications at different time. All of them, except lisinopril, have caused me to have near-fainting spells and other awful side effects. I stopped taking them after a week or so.

I regularly take 5 mg Lisinopril in the morning and 10 mg at night. This high blood pressure has been with me for the past twenty years. Though I believe I have made the best choice, it is difficult to maintain that belief. Doctors have managed to scare me over and over. The possibility of a stroke is very scary. As for the possibility of a heart attack, I would not give up a reasonable quality of life for that reason.
I have a meaningful life and can look after myself.

I am a very healthy woman of 84 and have been primary caregiver for my husband who died at home recently of Alzheimer's (probably caused by statins). I go to the gym several times a week and among other things, I always ride a recumbent bike at least 30-45 minutes. I am overweight about 20 pounds which I am working on. I eat very well - lots of fruits, veggies and mostly chicken.

My cholesterol is about 240 which I am working to lower. My blood pressure runs between 140/75 to 150/80. Taking Benicar resulted in day-long coughing fits and taking Norvasc resulted in brain-fog so I quit blood pressure drugs. Statin drugs caused awful pain in my legs and I quit it years ago. The women in my family lived very long happy lives - most over 90 and two over 100 without being dependent on drugs. I am so glad to see some in the medical establishment fighting back at the drug pushers. It's all about more profit for the drug companies.

Thank you for sharing this. I was one of the ones treated for mild hypertension a few years ago. My doc did not believe I had white coat hypertension and insisted on medication. I had terrible side effects from the meds and decided on my own to discontinue the treatment. The one positive that came from all of this, was that I felt so terrible on the meds that I changed my lifestyle - more cardio workouts and vegetarian diet. It works. I take my own BP, but still have higher readings when in the Dr's office - I call it flunking blood pressure in the medical setting. I'm probably not the only with with this quirk!!

Thank you People's Pharmacy for your upfront, on target information. I do truly believe the big drug companies need to be held to task, for their drug industrial complex, has harmed many.

Most importantly, a good diet, exercise, weight control will solve many problems. I am so weary, so tired of big drug companies selling their pills on TV, radio. What they and all doctors should be selling is a good diet, exercise and weight control.

Obesity is the cause of early demise. I am always appalled when a doctor, supported by drug companies, states... I have the pill to cure your ills: ie: smoking, weak bladder, etc. etc. As a senior citizen, we all endure aging discomforts, that is life, unfortunately, so many seniors have been harmed more by the so called cure... thanks to big drug companies.

I take Valstartan, 80/12.5. The only medication I take. My goal has always been to lessen the dose. I would take 1/2 a pill every day and kept my blood pressure between 125-135/80-90. Because of a poor diet (vacation)My pressure went up to 159/95. i had a Dr's appt and he became very upset and put me on Vslstartan 160/12.5. I stayed on it for a few weeks and gradually went back to my old BP medicine. You had an article on eggplant water, I started it, still drink it every day, 6-8 ozs in SF green tea, With 1/2 of 80/12.5 my BP is between 120-125 over 70-85. Sometimes lower. I've changed my diet. More fruit, veggies, lean meat no sugar. I'm a celiac, so no wheat, probably the best thing that ever happened to me.I've also lost 18 lbs and my cholesterol has lowered. My Dr is amazed at my blood work. He said whatever I'm doing keep doing it. I told him about the eggplant water. He had no comment. I'm 75.

I have chronic kidney disease and the doctor wants my blood pressure below 120 to protect my kidneys. It doesn't always stay that low, even with medication and I feel better when it's higher. Does it actually hurt my kidneys to have it higher (140/XX)?


I would say I welcome the new guidelines, it may be late for me but other will benefit from unnecessary use of BP medicine & treatment.

I was treated for 3 years with diuretic to lower my pressure of 135-140 systolic. Regrettably, I wound up in hospital for 3 weeks due to electrolyte imbalance not to mention seizures. My BP was never down to 120-125 systolic after prolong usage. Now, I am counting on Sugar beet, Hibiscus tea (expensive & had to drop it) and now added cinnamon powder.

I should say, if any one had BP of 135-140 systolic. Please forget to listen to your doctors for high BP medicine and adhere to good living practice. Exercise, eat healthy with lots of greens.

Some wise man said long time ago that, "follow the money" and you will learn the truth!!! Sometimes I wonder our medical system has become just a money making industry.....?????

Thanks for your input

would appreciate getting readers' comments on this question. Thanks.

I am 78 yrs old. At 74 my MD wanted me to try Lisenpril (sp??) as whenever I went to her office my BP shot up. I was told many years earlier that I had "white coat" reaction when going to the MD, probably because I absolutely hate going to an MD. I tried the med only to develop a horrible cough, something beyond anything else I had ever had. I stopped the meds.

I take no other meds, never get sick except for Morton's neuromas in the feet and some neuropathy caused by ???? I stick to a Mediterranean Diet and I got a BP cuff to monitor my pressure. I stay between 120-140/52-75. The only time it has shot up high (90/184) was when my dgtr-in-law died. It corrected within a short time. I still take no other meds and only fish oil, Vitamin D, and Vitamin B-12.

I hesitate to ever try a med again as I am allergic to Pencillin and react badly to Morphine (after surgery) and react to other meds over the years, very badly (usually reverse reaction). The reason I am telling you all this is that before a patient takes BP meds for "barely high" BP they should look at their diet. I have used only Olive oil all my life (heritage background), eaten lots of green veggies, and in recent years less meat and minimal to no sugars. My aunt who raised me lived to 103+ on that diet and 5 great aunts & uncles lived to 97-99. No cancer, no diabetes, no heart until the last years and stayed active and clear of mind. Genes play a big part of course, but I think diet was a bigger factor. Oh, the "greats" did use red wine at each dinner. Hope this might inspire someone to try diet - Dash or Med.

I have 'white coat hypertention' and my blood pressure is often high when it is first taken by the doctor's staff. They take it a little later, and it has come down. When I take my blood pressure at home, I have very low BP. Around 100-110/70. Or even lower.

f I was treated with drugs based on my first BP readings at the doctors office, it would be very dangerous for me. My BP has always dipped quite low, at times. Even to the point of causing dizziness. For some of us, taking our own readings at home is very important.

The BP pills (Lisinopril) seemed so unnatural that after going on and off several times, I had the incentive to make the change to a whole food, plant-based diet. For me, the pre-hypertension treatment did get me to find better ways to reduce blood pressure without side effects. I also use the Resperate to slow breathing.

Always fun for me to read about taking meds and their side-effects and now that in many cases, they don't even HELP. I have been blessed in 76 years on the planet to have worked hard at staying thin and fit since age 30 when I quit smoking. As a result, I take no medications - none, nada.

I always feel fantastic after my workout and then 3 cups of regular coffee in the AM. I am certain if I had to take meds, I would not feel this good. My wife takes BP meds even though her readings are below 150. She is too timid to quit the meds and won't even ask her MD if she really needs them.

I recommend starting at an early age to get in shape, eat right, exercise as hard as you can and don't take medications if you can possible avoid them

Some years ago, I went to a new primary care doctor; his examination indicated that I had "elevated" BP. He wanted to write an Rx. I said hold off. I contacted my former doc, then retired, who had seen me for 25 years, and asked if I had a history/pattern of high BP. He said no; I had experienced white coat syndrome. The new doc made me nervous, raising my BP. More recently, I was in hospital for wrist surgery. They checked my BP every hour I think. I asked about their readings; they were fine. I never returned to the 'script happy doc. But then he doesn't need my business; he has his friends in Pharmageddon.

Really like your program!

Donnie:
You have "White Coat" HTN. Do not know your age, but that BP 100-110/70 is too low. You are possibly over-medicated. If this is a combination therapy (2 or 3 drugs to control BP) the beta blocker dose is possibly too high to lower systolic like that (check your heart rate too). Most people are in a ACEI or an ARB (ex. are Lisinopril and or Lolsartan) plus a CCB (Amlodipine-Norvasc) and plus a Beta blocker (ex. metoprolol).

The best blood pressure reading is an average of 3 readings, done consecutively. However, the morning readings (due to high cortisol levels) are higher until 12 noon (that is the morning surge- for people prone to morning surge). Coffee can increase BP, sometimes 20 points, in the morning hours (depending how strong is the coffee- expresso, etc.). Decaff coffee has some % of caffeine too. So be moderate with coffee. Tea has caffeine too, as well as carbonated beverages. Avoid all caffeine.

OP, PharmD

No, I am not over-medicated with BP drugs. I have never taken them in my life. My BP has always been very low. I have Hashimoto's hypothyroid disease which may be a factor. My BP could dip down to 72/56 area, at times. Since my Celiac diagnosis a few years ago, my BP went up a bit, to what it runs now. It's possible that I've had Celiac most of my life, but was never tested until 2004. I've had anaphlaxis and my BP has dropped very low, too. I also have relatives who have the problems with very low BP. Along with our hereditary autoimmune diseases.

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