Understanding the New Blood Pressure Guidelines

2/24/2014

The ten-year-old blood pressure medication guidelines were updated last fall, resulting in the allowance for blood pressure to be higher in adults over the age of 60 before medications are recommended.

Now, blood pressure medication isn’t recommended until the reading is over 150/90 for older adults; a higher threshold from the previous guideline of 140/90 issued in 2003. These results were published in the Journal of the American Medical Association.

For patients under the age of 60 who have diabetes or kidney disease, blood pressure medication should be recommended when the reading exceeds 140/90, an increase from the previous benchmark of 130/80.

The recommendations were made after the panel reviewed 30 years of clinical evidence showing that stricter guidelines did not provide additional health benefits to patients. When blood pressure was reduced below 150 in older adults, the anticipated benefit of a lower risk of stroke and heart failure did not materialize.

“Older adults often take many medications, which can begin to interfere with each other. If the results aren’t proving the effectiveness of the medication, it’s wise to step back and make sure the patient is truly benefiting before continuing to prescribe the pills,” said Chris Thompson, MD, FACS, cardiologist with the Heart and Vascular Center and medical staff member of West Calcasieu Cameron Hospital (WCCH).

According to co-chair of the guideline committee Dr. Paul James, “We couldn’t see additional health benefits of driving blood pressure lower than 150 in people over 60 years of age. We were particularly concerned about medication side effects in the elderly population like lightheadedness and dizziness, which increases the risk of falling and broken bones.”

For everyone else – those under the age of 60 without kidney problems or diabetes – the recommendation for blood pressure to be at or below 140/90 remains the same.

About one in three adults in the United States has high blood pressure, according to the U.S. National Heart, Lung, and Blood Institute.

Normal blood pressure for an adult is considered 120/80. The upper reading, or systolic pressure, measures the force of the heart contracting and pushing blood out of its chambers. The lower reading, or diastolic pressure, measures the force as the heart relaxes between contractions.

“Anything above 140/90 is still considered to be high blood pressure,” explained Dr. Thompson. “The new guidelines offer evidence to physicians on the benefits and recommendations for treating it.”

It’s important for patients to not take the role of physician and stop taking their medication without checking with their doctor. “It is always recommended to talk with your doctor before ceasing any medication. Every patient’s needs are unique and your doctor knows your medical history. Regardless of the medication, it should only be started after a conversation with your doctor of the potential side effects and the risks and benefits,” said Dr. Thompson.

Lifestyle changes should be the first line of defense to reduce blood pressure. Regular exercise and a healthy diet should be in place before medications are discussed. A low-sodium diet that includes plenty of fresh fruit and vegetables is beneficial for heart health, as well as losing excess weight through a healthy diet and regular exercise.

“The release of these guidelines is a good time for a conversation with your doctor to see how he or she interprets them for your particular situation,” said Dr. Thompson.

For mild hypertension in adults over 60, these recommendations may result in a change in your prescription.

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