Two prominent doctors’ groups have published new guidelines about treating high blood pressure in people over 60.
The new guidelines, published Monday in the journal Annals of Internal Medicine, call for beginning treatment in those with a systolic blood pressure (top number) of 150 or higher. They did not publish guidelines for bottom number treatment, saying the research is inconclusive.
“The evidence showed that any additional benefit from aggressive blood pressure control (under a top number of 150) is small, with a lower magnitude of benefit and inconsistent results across outcomes,” said Dr. Nitin S. Damle, president of the American College of Physicians, or ACP. “Most benefits of targeting of less than 150 mm Hg apply to individuals regardless of whether they have diabetes.”
According to the National Institute on Aging, or NIA, “normal” blood pressure is a top number of 120 or less and a bottom number (diastolic reading) of 80 or less. Top numbers of 140 and more and bottom numbers of 90 or more constitute “high blood pressure.” So, the new guidelines are a break from tradition.
There is such a thing as “low blood pressure,” and that happens when the bottom number falls below 90, per the NIA.
High blood pressure is known as “the silent killer” because many people do not experience symptoms until a major event such as a heart attack or stroke, which can be deadly. Accurate blood pressure readings by a physician are the best way to make sure one’s blood pressure is within range.
The guidelines also note that some patients have “white coat hypertension” – that is, when they go to the doctor they are nervous and so their blood pressure readings may be elevated only temporarily. “Therefore, it is important for physicians to ensure they are accurately measuring blood pressure before initiating or changing treatment for hypertension,” according to a news release from the journal.
“The most accurate measurements come from multiple blood pressure measurements made over time,” said Dr. John Meigs, Jr., president of the American Academy of Family Physicians, or AAFP. “These may include multiple measurements in clinical settings or ambulatory home-monitoring.”
The new guidelines were co-published by ACP and AAFP. Together, the groups represent 272,900 members including family practice and internal medicine doctors. These specialties treat most Americans with high blood pressure, also known as hypertension.
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For those with a history of stroke or transient ischemic attacks (also known as TIAs, or “mini strokes”), or with other known cardiovascular risks, the guidelines call for starting treatment with consistent top numbers of 140 or higher.
The doctors’ groups said physicians should prescribe generic drugs which will improve patient adherence to the medications due to their lower cost.
Elderly people have an increased risk of high blood pressure. Males and African Americans are also at higher risk.
Often, blood pressure can be controlled by making some lifestyle changes. The NIA recommends maintaining a healthy weight, lowering salt intake, eating a well-balanced diet, exercising regularly (ideally 30 minutes every day), avoiding alcohol and cigarettes, and getting a good night’s sleep consistently.