When the Eighth Joint National Committee issued recommendations on blood pressure management in February, it set off a firestorm among physicians who were surprised that the JNC8 had advised against treatment for patients 60 and older whose blood pressure fell below 150/90. Treatment had previously been recommended for patients whose blood pressure was above 140/90.
Using data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey, researchers from Duke University estimated how many adults would be reclassified as a result of the new study.
“What our findings show is that there are a lot of adults who fall into the gray area [a systolic blood pressure between 140 and 150], an area for which there is no consensus,” explained Dr. Ann Marie Navar-Boggan, cardiology fellow at Duke University, and lead author of the study.
One in five of all adults over age 60 who were previously considered to have uncontrolled blood pressure would now be considered as meeting healthy blood pressure targets, and would not need to begin drug therapy or increase their current medication, Navar-Boggan said. These older adults would still need to monitor their pressure and should be encouraged to make lifestyle modifications, such as getting more exercise and reducing sodium intake, she said.
“This suggests that patients and doctors really need to have individual discussions about the potential risks and benefits of taking medication, rather than just implementing the guidelines for everyone, and assuming everyone is the same,” Navar-Boggan said.
Though not surprised by the number of adults who would be affected, what most stood out in the study, she says, was that even with the new, less restrictive, recommendations, there are still 27 million Americans with uncontrolled blood pressure.
“Even with less stringent targets, we still have a major problem with uncontrolled blood pressure in adults, both over and under the age of 60,” she said. The findings published in JAMA, are being released today to coincide with the American College of Cardiology Annual Scientific Session taking place March 29-April 2 in Washington.
According to the CDC, about 1 in 3 U.S. adults—or 67 million people—currently have high blood pressure, and only about half have their condition under control. According to the American Heart Association, managing high blood pressure is the most important way to reduce stroke risk, the fourth leading cause of death in the U.S.
The debate about how to handle patients who fall in the “gray area” for high blood pressure were reignited in March, when a Neurology study concluded that stroke risk was elevated for any patient with a blood pressure reading above the optimal level, not just those with hypertension. Drug interventions are typically reserved for those who have been diagnosed with high blood pressure, but the Neurology study suggested aggressive treatments might also be needed for individuals whose blood pressure is consistently elevated.
Though the best blood pressure level for older patients remains unclear, there is one general consensus—getting patients' blood pressure under control is critical to managing a significant U.S. public health threat.
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