New recommendations on treating high blood pressure

The New York Times reports that “new guidelines suggest that people over 60 can have a higher blood pressure than previously recommended before starting treatment to lower it.”

The guidelines committee, “composed of 17 academics, was tasked with updating guidelines last re-examined a decade ago.” The recommendations were published in The Journal of the American Medical Association.”

The AP reports that “the panel completed its work earlier this year, around the same time that the National Heart, Lung and Blood Institute announced that it was getting out of the guidelines business and turning the job over to the American Heart Association and American College of Cardiology.”

The Wall Street Journal points out that neither the American College of Cardiology nor the American Heart Association vetted the document, nor did the NHLBI.

The Los Angeles Times “Science Times” blog reports that “rather than aim for a target blood pressure of 140/90 mm Hg, the target will be relaxed slightly to 150/90 mm Hg, according to” the “new guidelines.” The guidelines’ authors “emphasized that they were not changing the definition of high blood pressure.”

Instead, “they are recognizing that data from randomized clinical trials do not show that using drugs to nudge down systolic blood pressure from 150 to 140 provides any health benefit.”

Bloomberg News reports that individuals aged “60 and older were focused on in the guidelines because they ‘are a unique population and we are concerned about the number of medications that may be required,’ said Paul James, the lead author of the article.”

According to the Boston Globe, “a number of cardiologists … complained that the new guideline was not issued by any major medical group or government entity.” Harlan Krumholz, MD, discusses the guidelines in the New York Times “Well” blog, and concludes:

In summary, this is a large paradigm change. The authors state that they did not intend to redefine what constitutes high blood pressure, but in effect they have now set it at 150/90 for the purpose of drug treatment of the general population. They have illuminated the weakness of our current body of evidence and made sensible recommendations given what we know.

The new guidelines are a reason for people being treated for high blood pressure to start 2014 with a discussion with their doctor, particularly if they started drug treatment for mildly elevated blood pressure.

As always, all decisions about your treatment should reflect your own preferences about whether the benefits are worth the risks.

What these guidelines reveal is that many decisions about blood pressure treatment are being made with less evidence than we need.

This is a call to action for studies that can equip patients facing decisions about treatment with the information they need.

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