When Do We Treat Blood Pressure? New Guidelines After Thirty Years.

Regulating Blood Pressure (NASA, International...
Regulating Blood Pressure (NASA, International Space Station) (Photo credit: NASA’s Marshall Space Flight Center)


Well, I am so glad to hear the new guidelines about blood pressure.  Millions of older patients are taking blood pressure medications unnecessarily and possibly detrimentally to their health.


The committee on hypertension (as reported in the New York Times here)  came up with a conservative increase of ten points, raising the threshold for treatment to 150 from 140.  The bottom number (diastolic) stays at 90.  Anyone taking medication who started taking that medication with a first number below 150 should talk to their doctor about coming off medication.


The NYT article did not go into detail, but the JAMA abstract (here) is pretty clear about other goals.  Anyone under sixty should really discuss blood pressure with their doctors as the committee found: “there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal.” Those are strong words for a policy that has been in place for decades.


In the recommendations for treating blood pressure the committee named many medications but notably left out beta-blockers as a first treatment.  We’ve known for almost a decade that beta-blockers should not be a first line treatment for high blood pressure.


My own frustration with hypertension is the continuing reliance on in-office blood pressure readings to diagnose it.  White coat syndrome is not a rare condition, it is a very real common situation that confounds in-office readings.  Home readings should be the gold standard for the diagnosis and any in-office readings should be taken with a very large grain of potassium or low-sodium salt substitute.


I posted the information on white syndrome several years ago on my google blog. (here) The short summary is that 72% of patients had white coat syndrome and that the average change in blood pressure was 50 points systolic and 18 points for diastolic.  Those numbers are more than enough to include the majority of patients currently being treated if the diagnosis is based only on in-office readings.




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