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.