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New Blood Pressure Guidelines Create Confusion

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Patients get confused when doctors feud. That's why controversial new guidelines for blood pressure treatment are causing consternation.

A committee of experts took five years to review all the available evidence and make recommendations for optimal blood pressure treatment. They are urging their medical colleagues to start drug treatment of older people (over 60) only when systolic blood pressure hits 150.

Many prominent cardiologists disagree. They want to stick with the old guidelines that focused on getting blood pressure down to 140 or lower.

You wouldn't think 10 points would create such concern, but millions of older people will be affected. The previous guidelines were used as benchmarks: did the doctor get patients' blood pressure to 140/90 or lower? Doctors sometimes pushed blood pressures much lower than that in their zeal to meet the target.

In elderly people, lowering blood pressure so much may require three or even four medications. They may experience side effects from these drugs.

Blood pressure pills frequently cause dizziness, especially in older people. A study from Canada last year demonstrated that elderly people are at a significantly increased risk of falls and fractures during the first several months on a new blood pressure medication (Archives of Internal Medicine, Dec. 10/24, 2012). Since a hip fracture in an older person can lead to disability or death, these complications need to be taken seriously.

Nobody is suggesting, however, that really high blood pressure should be ignored or go untreated. Severe hypertension is a killer.

The problem with the previous guidelines, though, is inadequate evidence to support drug treatment at the lower target level of 140. The gold standard for establishing best practice rests on randomized, double-blind, placebo-controlled trials. But there just aren't many studies showing that drug treatment of mild to moderate hypertension saves lives.

In fact, an analysis of all the available randomized controlled trials (RCTs) concluded last year: "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. Treatment caused 9 percent 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." (Cochrane Database of Systematic Reviews, Aug. 15, 2012)

There is no controversy about the value of controlling blood pressure with lifestyle changes. The DASH (Dietary Approaches to Stop Hypertension) diet has been proven effective. Exercise and weight loss are also helpful. For more about these and other natural approaches, we offer our Guide to Blood Pressure Treatment

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6 Comments

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I know of two people who were given two or more blood pressure drugs at the same time, to get their blood pressure below 120/70. Both of them died, but their exact cause of death was unknown. The new guidelines might have saved them, because their untreated BP wasn't over the new numbers.

Unfortunately, many doctors seem to feel that getting patients to target levels is some sort of a contest. The problem is that many doctors get a license to practice medicine and never take the time to keep abreast of medical evolution. The FDA and AMA mandate guidelines which become medical scripture. Protocols and flawed accepted medical practices are detrimental to medical diagnoses. The fear of malpractice lawsuits further hamper the application of logical or reasonable treatment.

As a result doctors have become warm-blooded robots tied to computerized analyses. There are thousands of otherwise healthy victims of the system who are tied to arbitrary targets. White Coat Syndrome results in thousands of prescriptions for hypertension drugs.Irrational fear of cholesterol leads to overzealous use of statins to reach arbitrary goals that in many cases do more harm than good in many cases leading to conditions such as diabetes and muscle disorders.

People's Pharmacy response: Your view of doctors is unnecessarily harsh. One reason some focus on getting patients to target is that they believe that is in the patient's best interests. Another reason is that they may get docked if too many of their patients don't reach target.

I often wonder, as a health care practitioner, now retired, if the lowering of blood pressure might correlate with dementia in the elderly. I have not seen any studies done. It seems lower blood perfusion might cause some ischemic changes in gray matter.
Any comments appreciated.

I posted a comment several months ago about my intention to get off blood pressure meds. In my case, Benicar40. I tapered off for 6 weeks, and discontinued it altogether. Two weeks later I saw my new physician for the first time. My bp was 132/85. When I saw him four weeks ago it was 122/66. The only change I made was to switch to de-caf coffee. I drink a lot of coffee.

Anyway, that's the best bp reading for me ever. No meds. I love it. Please don't take this as a recommendation that you do this. Every one is different, and my circumstances made me sure that I no longer needed this medication. This took months of research and consideration before I reached that conclusion. I know that a lot of common maladies can be controlled by diet and exercise, and I make the most of it. Thanks P.P. for giving us info that improves our quality of life.

Is it true that diabetics should have their blood pressure below 120/80, and that the U.S blood pressure guidelines are too high for people with diabetes? I am concerned because I was officially diagnosed with diabetes based on an A1c of 6.5 in my mid-30's but I was on an antidepressant, and such meds are known to raise blood sugar in those susceptible to diabetes.

But I've been off this med for 5 years and my blood sugar has hovered between A1c of 5.6 to 5.9. My doctor has never mentioned blood pressure meds for me, however. So, I'm just curious if others have been told to take BP meds upon a diagnosis of diabetes.

High BP, over 150/90, is worse for diabetics but the miracle of science is that nothing is simple:
E.g., if research says those with 120/80 have a third the problems of those with 150/90, wouldn't it make sense for the 150's to reduce to 120?
No, that would be a theory to test. What the research appears to say is if the 150s drop to 120 with meds, they still have triple the problems, doesn't make sense but is certainly possible. I'm take bp med, know it reduces bp, but don't know if it improves health.

On the other hand, I eat a lot of cheese and eggs, have low cholesterol (which doesn't make sense,) It wouldn't be good if I had high cholesterol. If I then took meds to reduce it, I'd have lower cholesterol, but maybe worse health, or better, careful comparison studies needed.

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