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    New Blood Pressure Guidelines

    Expert panel says treating some earlier with drugs shows little benefit, but other groups express concern


    In November, the AHA and ACC released their own joint set of treatment guidelines for high blood pressure, as well as new guidelines for the treatment of high cholesterol that could greatly expand the number of people taking cholesterol-lowering statins.

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

    The institute formed the Eighth Joint National Committee, or JNC 8, in 2008 to update the last set of high blood pressure treatment guidelines, which were issued in 2003.

    In June 2013, the institute announced that it would no longer participate in the development of any clinical guidelines, including the blood pressure guidelines nearing completion.

    However, the announcement came after the institute had reviewed the preliminary JNC 8 findings. The JNC 8 decided to forge ahead and finish the guidelines.

    The recommendation to start seniors on medication at a higher blood pressure reading is based both on evidence of the medical benefit as well as concern over potential drug interactions and high drug costs, James said.

    "The elderly are more likely to have other diseases that require medication. It's not uncommon for me to see people who are on 10 different medications for various illnesses," he said. "If we don't see evidence of improved health benefits, then the question becomes why add those additional medicines?"

    The definition of high blood pressure -- anything above 140/90 -- remains the same under the new guidelines, James said. Lifestyle changes should be used to treat people who have high blood pressure readings that fall below the level where medicine is needed, he explained.

    The panel also recommended a "toolbox" of four different blood pressure medications that doctors could use treat patients -- diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs).

    "It gives options for physicians to begin treatment, and all classes have generic versions available," James said. "This is a slight difference from JNC 7, where they preferred the diuretic class as the preferred first choice. We didn't see significant differences between the four classes at improving health outcomes."

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