New guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) state that all adults should get their systolic blood pressure to 130 or lower and their diastolic blood pressure to 80 or lower (Circulation, Nov. 13, 2017). That is 10 points lower than prior recommendations. Will lowering blood pressure to such levels prevent heart attacks and prolong life? Read on for a controversial answer.
What Do the Guidelines Mean for You?
The AHA/ACC experts have determined that nearly half of the adult population of the U.S. has high blood pressure. That means over 100 million adults will now have a diagnosis of hypertension in their medical record.
If your blood pressure in the doctor’s office is higher than 130/80 you will be considered hypertensive. For otherwise healthy people, this could be worrisome. Some people react to a diagnosis of hypertension with anxiety and fear (Hypertension, Sept. 2010).
The Upside of Lowering Blood Pressure:
The hope is that the new guidelines will increase hypertension awareness so that people can make changes in their diet and exercise patterns. It might be just the motivation needed to help many lose weight. That alone can lower blood pressure.
The Downside of the Guidelines:
Most health professionals are not equipped to help people make the challenging lifestyle changes necessary to lose weight, eat healthier foods and exercise more. Health coaching is a relatively new field. We suspect that most physicians have not been taught how to motivate their patients to make meaningful and sustained lifestyle changes.
It’s very likely that more people will end up taking blood pressure pills. Many will be prescribed multiple medicines to achieve the new blood pressure goals. That is something that is taught in medical school.
Revisiting the 2013 Statin Guidelines:
The 2017 AHA/ACC BP guidelines remind us a lot of the statin guidelines these same cardiology organizations announced in 2013. A research letter in JAMA Internal Medicine (online, Nov. 17, 2014) noted that if doctors followed those guidelines, 97% of Americans between 66 and 75 would be prescribed statins.
Not surprisingly, those statin guidelines were highly controversial. Not all cardiologists agreed that most older people, regardless of health status, should be on statins.
Read more about the controversy at this link:
All Adults Between 66 and 75 Should Be on Statins! Really?
and
Should Half of All Adult Americans Takes Statins?
The Controversy About Lowering Blood Pressure:
Lowering blood pressure below 130/80 is supposed to help people live longer, healthier lives. How good are the data to support this approach?
A brand new meta-analysis published this week in JAMA Internal Medicine (Nov. 13, 2017) calls into question the assumption that aggressive blood pressure treatment saves lives. The Swedish investigators analyzed 74 clinical trials involving over 300,000 patients.
For people whose systolic blood pressure was over 140, blood pressure treatment made an important difference. But for healthy people with pressure below 140, medications to lower it further did not prolong life or prevent heart disease.
The authors state that:
“These results refute the previous view…that lower is always better” for otherwise healthy individuals. Their conclusion:
“Treatment to lower BP is associated with a reduced risk for death and MACE [major adverse cardiovascular events] if SBP [systolic blood pressure] is 140 mm Hg or above. If SBP is below 140 mm Hg, treatment is not associated with any benefit in primary prevention, but may reduce the risk for several cardiovascular outcomes in people with previous CHD [coronary heart disease]. These results do not support lower BP goals in general, but they opt for potentially lower targets in CHD secondary prevention.”
People’s Pharmacy Perspective on Lowering Blood Pressure:
The Swedish meta-analysis of 74 clinical trials involving more than 300,000 patients is quite comprehensive. We interpret their findings this way:
1) If your systolic blood pressure is higher than 140, getting it down will help prevent cardiovascular disease and prolong life.
2) If you have have never had a heart attack or stroke or a diagnosis of heart disease and your systolic blood pressure is already below 140, medicine to lower it even more does not appear to make a difference.
3) If you have had a heart attack or stroke or have been diagnosed with heart disease, getting blood pressure below 140 “might offer additional protection.”
In our opinion, the Swedish conclusion contradicts the new guidelines from the American Heart Association that aim for half of all American adults to strive for lowering blood pressure below 130/80.
If people can get their blood pressure lower by losing weight, exercising and eating healthy food, that is fabulous. We are totally on board with such a program!
If someone has to take four or more medicines to achieve the new guidelines and then suffers dizziness, constipation, swollen ankles, cough or depression as a consequence, we’re not sure the trade off is worthwhile. No one should ever stop prescribed medicine without discussion with a health professional!
Share your own thoughts on the new guidelines in the comment section below.
