High Blood Pressure Goals Lowered for People 60 and OlderMichelle Fay Cortez
People 60 and older don’t need to be treated as aggressively for high blood pressure, according to new physician guidelines that may help lower the number of medicines taken by Baby Boomers.
The recommendations, published in the Journal of the American Medical Association, suggest treatment goals for older people should be set at 150-over-90 mm Hg, based on studies showing these patients fare just as well over time at this higher level. The goal for other groups is 140 over 90, according to the new guidelines by a panel convened by the U.S. National Heart, Lung and Blood Institute.
Hypertension increases the risk of heart disease, the leading cause of death worldwide. Studies show about 90 percent of people may eventually develop it. While the changes probably won’t reduce how many people are treated for hypertension, the new goals may help reduce the number and types of pills taken by older patients, doctors suggested.
“Hypertension is a disorder that requires many medications and the patient doesn’t feel any better when you treat them,” said Richard Krasuski, a Cleveland Clinic cardiologist who wasn’t involved in writing the guidelines. “That’s what makes this a daunting condition. It has been very challenging to get people to these lofty goals we’ve had in the last decade.”
Many people who suffer from hypertension require several types of drugs for their treatment, which can extend life by more than two years.
Drugs to treat hypertension are the third-biggest-selling class of medicines worldwide, according to IMS Health, a market research company. The medicines, sold alone or in combination with other drugs, generated $51.6 billion in 2012.
People age 60 and older were focused on in the guidelines because they “are a unique population and we are concerned about the number of medications that may be required,” said Paul James, the lead author of the article and chairman of family medicine at the University of Iowa in Iowa City. “There are side effects from each and every medication and there may be drug-drug interactions.”
The guidelines give doctors greater leeway when deciding which drug to prescribe to prevent heart disease.
Four popular classes of medicines were equally recommended as appropriate initial therapy, including ACE inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-type diuretics.
The last guidelines, published in 2004, said treatment should start with diuretics and then add other medicines as needed. All have been shown to slash the risk of heart attack, stroke and kidney disease while prolonging life.
“We think all of these drugs will improve patient health,” James said. “A special emphasis was placed on making our guidelines simpler and easier to follow by clinicians.”
The changes don’t mean patients should be taken off their existing medications if they are doing well, James said. No one should stop or change what drugs they take without first discussing the issue with their physician, he said.
The guidelines also change the goals for people with kidney disease and diabetes, saying they should be treated at the standard 140 over 90 for patients under age 60. Previously, the goal was 130 over 80.
The top number in a blood pressure reading is the systolic rate and shows the pressure when the heart beats. The lower number is the diastolic reading, which measures the pressure between the heart beats. Doctors may struggle with a change that emphasizes treatment based on diastolic blood pressure reading, after years of focusing on systolic levels, said Krasuski, who is director of the Cleveland Clinic’s Adult Congenital Heart Disease Center.
Automated blood pressure reading machines do a better job with systolic than diastolic levels, making it important that doctors routinely check blood pressure themselves, he said.
“This will put more of a burden on the clinicians to make sure they collect the blood pressure themselves,” he said. “The numbers are more accurate that way.”