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. 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 longterm, 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