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    New Blood Pressure Guidelines

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


    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.

    "They laid the evidence out in a really crystal clear way, and were really careful to make recommendations you could trace back to the evidence without asking, 'How did they come up with that?'" Sox said.

    "Even though they didn't send the guidelines to AHA and ACC, their documentation of the review process was so thorough that I, for one, was convinced they couldn't have learned anything more than what was learned in the initial review process," Sox added.

    Dr. Curtis Rimmerman, a staff cardiologist at the Cleveland Clinic in Ohio, said he will weigh the new recommendations in his future treatment decisions.

    "I'm going to have to go along with what I think are responsible people doing responsible acts," he said. "I don't think it's going to change my practice very much, but I want to digest this information further. In some patients, I may relax some of my blood pressure goals, particularly among more elderly patients who are taking many medications."

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