New guide­lines change high blood pres­sure thresh­olds

The Daily Star (Lebanon) - - LIFE - By Mar­i­lynn Marchione

ANA­HEIM, Calif.: New guide­lines lower the thresh­old for high blood pres­sure, adding 30 mil­lion Amer­i­cans to those who have the con­di­tion, which now plagues nearly half of U.S. adults.

High pres­sure, which for decades has been a top read­ing of at least 140 or a bot­tom one of 90, drops to 130 over 80 in ad­vice an­nounced Mon­day by a dozen med­i­cal groups. The change means an ad­di­tional 14 per­cent of U.S. adults have the prob­lem, but only an ad­di­tional 2 per­cent will need med­i­ca­tion right away; the rest should try health­ier life­styles, which get much stronger em­pha­sis in the new ad­vice. Poor di­ets, lack of ex­er­cise and other bad habits cause 90 per­cent of high blood pres­sure.

“I have no doubt there will be con­tro­versy. I’m sure there will be peo­ple say­ing ‘We have a hard enough time get­ting to 140,’” said Dr. Paul Whel­ton, a Tu­lane Univer­sity physi­cian who led the guide­lines panel.

But the risk for heart dis­ease, stroke and other prob­lems drops as blood pres­sure im­proves, and the new ad­vice “is more hon­est” about how many peo­ple have a prob­lem, he said. Cur­rently, only half of Amer­i­cans with high blood pres­sure have it un­der con­trol.

The up­per thresh­old for high blood pres­sure has been 140 since 1993, but a ma­jor study two years ago found heart risks were much lower in peo­ple who aimed for 120. Canada and Aus­tralia low­ered their cut­off to that.

Europe is still at 140 but is due to re­vise its guid­ance next year.

The guide­lines were an­nounced Mon­day at an Amer­i­can Heart As­so­ci­a­tion con­fer­ence in Ana­heim.

WHAT THE CHANGES MEAN

The guide­lines set new cat­e­gories and get rid of “pre­hy­per­ten­sion”: Nor­mal: Un­der 120 over 80 El­e­vated: Top num­ber 120-129 and bot­tom less than 80

Stage 1: Top of 130-139 or bot­tom of 80-89

Stage 2: Top at least 140 or bot­tom at least 90

That means 46 per­cent of U.S. adults have high pres­sure (stages 1 or 2) ver­sus 32 per­cent un­der the old lev­els. How com­mon it is will roughly triple in men un­der 45, to 30 per­cent, and dou­ble in women of that age, to 19 per­cent.

For peo­ple over 65, the guide­lines undo a con­tro­ver­sial tweak made three years ago to re­lax stan­dards and not start medicines un­less the top num­ber was over 150. Now, every­one that old should be treated if the top num­ber is over 130 un­less they’re too frail or have con­di­tions that make it un­wise.

“The ev­i­dence with this is so solid, so con­vinc­ing, that it’s hard to ar­gue with the tar­gets,” said Dr. Jack­son Wright, a guide­lines panel mem­ber from Univer­sity Hos­pi­tals Cleve­land Med­i­cal Cen­ter. Older peo­ple “have a 35-to-50-fold higher risk of dy­ing of a heart at­tack or stroke com­pared to younger peo­ple.”

But the Cleve­land Clinic’s Dr. Steven Nis­sen said he’s wor­ried.

“Some more vul­ner­a­ble pa­tients who get treated very ag­gres­sively may have trouble with falls” be­cause too-low pres­sure can make them faint, he said.

WHO NEEDS TREAT­MENT

Cer­tain groups, such as those with di­a­betes, should be treated if their top num­ber is over 130, the guide­lines say. For the rest, whether to start med­i­ca­tion will no longer be based just on the blood pres­sure num­bers. The de­ci­sion also should con­sider the over­all risk of hav­ing a heart prob­lem or stroke in the next 10 years, in­clud­ing fac­tors such as age, gen­der and choles­terol, us­ing a sim­ple for­mula to es­ti­mate those odds.

Those with­out a high risk will be ad­vised to im­prove their life­styles – lose weight, eat healthy, ex­er­cise more, limit al­co­hol, avoid smok­ing.

“It’s not just throw­ing meds at some­thing,” said one pri­mary care doc­tor who praised the new ap­proach, the Mayo Clinic’s Dr. Robert Stroebel. If peo­ple con­tinue bad habits, “they can kind of eat and blow through the medicines ,” he said.

The guide­lines warn about some pop­u­lar ap­proaches, though. There’s not enough proof that con­sum­ing gar­lic, dark choco­late, tea or cof­fee helps, or that yoga, med­i­ta­tion or other be­hav­ior ther­a­pies lower blood pres­sure in the long term, they say.

The gov­ern­ment no longer writes heart guide­lines, leav­ing it to med­i­cal groups. Un­like pre­vi­ous guide­line pan­els, none on this one have re­cent fi­nan­cial ties to in­dus­try, al­though some on a panel that re­viewed and com­mented on them do. The guide­lines were pub­lished in two jour­nals – Hyper­ten­sion and the Jour­nal of the Amer­i­can Col­lege of Car­di­ol­ogy.

WHEN, HOW TO CHECK IT

Blood pres­sure should be checked at least once a year by a health pro­fes­sional, and di­ag­nos­ing high pres­sure re­quires two or three read­ings on at least two oc­ca­sions. The com­mon way uses a cuff on the up­per arm to tem­po­rar­ily block the flow of blood in an artery in the arm and grad­u­ally re­lease it while lis­ten­ing with a stetho­scope and count­ing sounds the blood makes as it flows through the artery. But that is prone to er­ror, and many places now use au­to­mated de­vices.

The guide­lines don’t pick a method, but rec­om­mend mea­sur­ing pres­sure in the up­per arm; de­vices that work on fin­gers or are worn on wrists “aren’t ready for prime time,” Whel­ton said.

Home mon­i­tor­ing also is rec­om­mended; de­vices cost as lit­tle as $40 to $60.

WHAT ABOUT KIDS?

Un­like adults, num­bers for nor­mal pres­sure in chil­dren vary with age, height and gen­der. Kids should be checked at least once a year for high pres­sure, guide­lines an­nounced in Au­gust by the Amer­i­can Academy of Pe­di­atrics say. Af­ter age 13, the lev­els defin­ing high pres­sure are the same as for adults, said a mem­ber of the pe­di­atrics panel, Dr. Elaine Urbina of Cincinnati Chil­dren’s Hos­pi­tal Med­i­cal Cen­ter. “When you turn 18 years and 1 minute, you shouldn’t sud­denly have a new def­i­ni­tion,” she said.

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