For Seniors, High Blood Pressure Not What it Used to Be
New guidelines for the management of high blood pressure have been published by the Journal of the American Medical Association (JAMA). They were developed by an expert panel and contain recommendations and a treatment chart to help doctors treat patients with high blood pressure.
High blood pressure, also known as hypertension, is common around the world and the leading cause of heart disease. Many older adults with high blood pressure can be treated less aggressively, which could mean taking fewer pills to get it under control, according to the new guidelines. However, not all experts agree with the new recommendations, including the federal agency that selected the group.
Panel members assured that they are not changing the definition of high blood pressure, currently at 140 over 90. For adults 60 and older, they are recommending a higher treatment threshold, prescribing medicine only when blood pressure levels reach 150 over 90 or more.
The new guidelines address three questions related to a patient with hypertension:
1. At what BP should medication be started in patients with hypertension?
2. What BP goal should patients achieve to know they are enjoying proven health benefits from their medication?
3. What are the best choices for medications to begin treatment for high blood pressure?
Experience has shown that when blood pressure treatment is too aggressive, it can cause fainting and falls in older patients, or bad interactions with drugs they're already taking for other illnesses.
The panel does still endorse the lower target of 140 over 90 for younger adults, as well as for all adults who also have diabetes or kidney disease.
For many patients, multiple drugs are needed to bring their blood pressure down. Many older adults could probably reduce their doses, or take fewer drugs, to reach the new, less strict target.
The panel said their guidelines are simply recommendations, and that doctors should make treatment decisions based on patients' individual circumstances. The experts emphasized that everyone with high blood pressure can benefit from a healthy diet, regular exercise and weight control, which all can help lower blood pressure.
High blood pressure symptoms are also caused by factors which are within our control - such as an unhealthy diet, being overweight, or a high alcohol intake. Too much salt in the diet is also a contributing factor – most Americans consume more salt than they need. A lack of exercise can also contribute to it – and as everyone knows, stress is one of the major causes of high blood pressure.
People with naturally low blood pressure have a lower risk of cardiovascular problems and live longer. High blood pressure, when left uncontrolled, can lead to heart attack, stroke, and aneurysm. Smoking, obesity, and inactivity are all risk factors for high blood pressure, which also has a genetic component that's passed down in families.
However, not everyone gets their blood pressure low enough with just lifestyle changes, and if that first number climbs above 140, you officially have high blood pressure, or hypertension. High blood pressure affects about two-thirds of people 60 and older.
About 50 million Americans are on blood pressure drugs of all different kinds, including diuretics ("water pills"), beta blockers (which slow your heartbeat), and ACE inhibitors (which help stop blood vessels from narrowing).
Other experts like the American Heart Association are concerned that there's not enough evidence that driving that number all the way to 140 — rather than simply to 150 — provides much additional benefit. Most experts agree that more research needs to be done.
The new target numbers are like speed limits: If you tell people the maximum speed is 65, they may drive at 75. To that line of thinking, leaving the target at 140 may mean more Americans actually bring their number below 150.
Understand that following these new guidelines is up to your doctor. Blood pressure is just one risk factor for heart disease, and people using medication to maintain a number in the 140s without serious side effects should not suddenly stop and let that number drift up.
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