A report published late in 2013 recommends healthcare providers take a new approach to treating high blood pressure for people older than 60. But based on the current research available, the American Heart Association recommends that healthcare providers continue to follow existing guidelines for treating high blood pressure.
“We believe there’s just not enough evidence at this point to justify such a major change in how we treat people with high blood pressure,” American Heart Association President Mariell Jessup, M.D., said of the new opinion published in the Journal of the American Medical Association.
One in three American adults has high blood pressure, which is a reading of 140/90 millimeters of mercury or higher. The opinion published in JAMA advises treatment at 140/90 for adults from ages 30 to 59, but starting only at 150/90 for people 60 and older. The American Heart Association maintains its recommendation of initiating treatment — starting with lifestyle changes and then medication if necessary — at 140/90 until age 80, then at 150/90.
High blood pressure is undertreated and underdiagnosed among all races and genders, and those with high blood pressure often face serious cardiovascular problems such as stroke, heart attack or heart failure. Lower blood pressures are strongly associated with a lower incidence of heart disease and strokes.
“Much of our great success in reducing deaths from stroke has been attributed to better blood pressure control,” said Jessup, the medical director of the Penn Heart and Vascular Center, professor of medicine and associate chief of clinical affairs in Cardiology at the University of Pennsylvania School of Medicine in Philadelphia.
“However, even with the current target of less than 140, many individuals have high blood pressure that is out of control, and they continue to be at serious risk, especially for heart failure and for stroke,” she said. “If the target is raised, almost certainly blood pressure in many people will be even higher.”
Elliott Antman, M.D., president-elect for the American Heart Association, said the new recommendation could expose many more people to health-related problems from high blood pressure.
“Hypertension influences a person’s health status over a time horizon that is much longer than the follow-up of many of the randomized controlled trials included in the evidence review,” said Antman, professor of medicine and associate dean for Clinical/Translational Research at Harvard Medical School and a senior physician in the Cardiovascular Division of the Brigham and Women’s Hospital in Boston. “Therefore it’s not surprising that we still have uncertainty about the optimal way to evaluate and manage hypertension.”
The American Heart Association and the American College of Cardiology released four cardiovascular treatment guidelines for healthcare providers in November 2013, and some time in 2014 or early 2015 they will be updating their high blood pressure guidelines as well. The new report that was published in JAMA, the evidence review it was based on and an update of that review will be taken into consideration for those guidelines, which will be the national standard for treating hypertension.
Until then, the American Heart Association and the American College of Cardiology recognize the most recent hypertension guidelines, published in 2004 by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, as the national standard.
Talking to your doctor or other healthcare provider about the best treatment plan for your high blood pressure is key.
The American Heart Association, the American College of Cardiology and the U.S. Centers for Disease Control and Prevention recently published a simple approach for clinicians to use to safely control high blood pressure.
This approach was developed by an expert panel and contains a treatment algorithm or flow chart to help doctors treat patients with hypertension.
“We wanted road-tested evidence of programs and patient care strategies that work to bring blood pressure under control,” Jessup said. “It’s a useful tool to help people bring blood pressure down to a healthy level.”
The American Heart Association has a variety of tools that can help you control your blood pressure. This infographic can help you understand what you need to do to make healthy lifestyle changes, like knowing your numbers, losing weight, getting active and reducing sodium. You can also learn more information about controlling high blood pressure.
In this video, Dr. Kevin L. Thomas and Dr. Bimal Shah talk about how you can better control your blood pressure with the American Heart Association's Heart360 web application.
|In this video, Dr. Don Lloyd-Jones talks about high blood pressure and tips to manage blood pressure by reducing sodium intake.|