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New Blood Pressure Guidelines

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


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."

James emphasized that these are treatment guidelines for doctors. "Patients should not read these guidelines and take themselves off medications," he said. "These are recommendations that are intended for physicians who are highly trained professionals and will adapt them to individual patients' needs."

The JNC 8 reached its conclusions after reviewing more than 30 years of clinical studies. However, the AHA is concerned that those studies could not have assessed the full damage of long-term high blood pressure.

"The adverse effects of high blood pressure on a person's health may take many, many years to develop, longer than the follow-up period of many of the trials included in the evidence review," Antman said.

Epidemiologic evidence has shown that a lower blood pressure is associated with lower rates of strokes, heart failure and death, he added.

The guidelines issued by the AHA and the ACC call for lifestyle changes to treat people with a systolic pressure of 140 to 159 and a diastolic pressure of 90 to 99. Blood pressure levels greater than those should be treated by a combination of medication and lifestyle changes. Treatment would continue as long as the person had blood pressure higher than 140/90.

Even though the JNC 8 guidelines were not reviewed by the AHA or the ACC, the expert panel has provided enough transparency that its recommendations should be taken seriously, said Dr. Harold Sox, of the Dartmouth Institute for Health Policy and Clinical Practice.

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