The Garden Island - - Pau Hana Time -

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

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