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 Americans with blood pressure of 130/80 or higher should be treated,
down from the previous trigger of 140/90, according to new
guidelines announced on Monday by the American Heart Association and
the American College of Cardiology.
At the new cutoff, around 46 percent, or more than 103 million, of
American adults are considered to have high blood pressure, compared
with an estimated 72 million under the previous guidelines in place
since 2003.
High blood pressure accounts for the second-largest number of
preventable heart disease and stroke deaths in the United States,
second only to smoking.
The guidelines do not change the definition of normal blood pressure
as 120/80 or lower.
Potentially deadly high blood pressure can be brought under control
with a wide array of medications, many sold as relatively
inexpensive generics. The drug classes include angiotensin receptor
blockers, such as Novartis AG's Diovan, calcium channel blockers,
like Pfizer Incs's Norvasc, ACE inhibitors, including Pfizer’s
Altace, and diuretics, such as Merck & Co Inc’s Hyzaar.
But the drugs have side effects and the new guidelines emphasize
lifestyle changes including weight loss, diet and exercise as the
first tool for combating hypertension.
"I think this will encourage both patients to adhere to
recommendations but also clinicians to be more vigorous in their
attempts to prescribe lifestyle changes," said Dr. Pamela Morris,
chair of the ACC's committee on prevention of cardiovascular
disease.
Lifestyle modifications are the cornerstone for treatment, but the
guidelines also stress that patients assessed to be at high risk of
cardiovascular problems will be started on medication.
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A large, government-sponsored study of hypertension patients aged 50
and older showed in 2015 that death from heart-related causes fell
43 percent and heart failure rates dropped 38 percent when their
systolic blood pressure was lowered below 120 versus those taken to
a target of under 140.
But patients in the 120 systolic blood pressure group had a higher
rate of kidney injury or failure, as well as fainting.
Concerns about those side effects, as well as the fact that the
close monitoring seen in a clinical trial is hard to replicate, led
the AHA, ACC and other groups to select the 130 systolic blood
pressure target.
The new guidelines also emphasize the importance of accurate blood
pressure measurements, using an average of different readings at
different times.
Adults with blood pressure of 130/80 "already have double the risk
of heart attack compared to someone in the normal range," said Dr.
Paul Whelton, professor at Tulane University School of Public Health
and Tropical Medicine and School of Medicine in New Orleans and lead
author of the new guidelines. "It doesn't mean you need medication,
but it's a yellow light that you need to be lowering your blood
pressure, mainly with non-drug approaches."
(Reporting by Deena Beasley; Editing by James Dalgleish)
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