The cuffs are off as new blood pressure guidelines are released for individuals over 60 years of age. A panel of 17 academics and physicians now recommends not starting medication until a patient’s blood pressure is higher than 150/90 for this population. The new guidelines, however, have stirred up a ruckus, even among the panel, on what’s best to do.
As JAMA reports, hypertension is the most common condition doctors see in their offices and can lead to myocardial infarction, stroke, renal failure and death. However, after a “rigorous, evidence-based” approach to reviewing several studies, the panel recommended easing from 140/90 to 150/90 for patients 60 years of age and otherwise healthy.
The journal article goes on to state, “Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment.”
The New York Times commented that the evidence wasn’t strong enough to support the benefits with medication for those with a systolic pressure between 140 and 150 above age 60. Essentially, the risks of medication didn’t outweigh the benefits the patients were receiving.
Not all Panelists Agree
Last week five of the panelists published an article in the Annals of Internal Medicine saying they disagree with the new guidelines. They said the evidence to support the change to 150 SBP was “insufficient and inconclusive” and does not take into account certain ethnic groups at higher risk such as African Americans.
Since 1972, when blood pressure guidelines were first introduced, the incidence of stroke has fallen by 70 percent and heart failure rates have fallen by 50 percent. It is estimated that 30 million Americans have high blood pressure, although no one is sure how many people will fall under the new guidelines.
As a physician, what do you think is best for your patients? Will you continue to use the old guidelines or will you follow the new guidelines on a case-by-case basis? We will be continuing this conversation inside our online physician community, if you’re an M.D. or D.O., please join us.
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