The American Medical Association (AMA) on Tuesday released new clinical guidelines on high blood pressure that may lower medication rates for many seniors.
The new recommendations would raise the threshold for prescribing hypertension drugs to patients 60 and older, from 140/90 millileters to 150/90, while setting the former as a threshold for younger adults 30 to 59 years old. Today, nearly one in three Americans age 20 and older suffers hypertension, affecting 78 million older adults, according to the Centers for Disease Control and Prevention.
Paul James, a medical professor at the University of Iowa, predicted in the Journal of the American Medical Association that many patients would welcome the chance to eliminate one of several medications — or “horse pills” — composing their daily cocktail of prescription drugs. Evidence suggests patients benefit from reductions in blood pressure below the 150/90 threshold, with no further benefits afterward.
"While most doctors think it's OK to add another drug, most patients don't really like taking more medicine," James says. "Particularly if you can't prove a significant benefit, most people would opt out."
James led a group of 17 medical experts to revise the guidelines, which recommend that clinicians regularly assess blood pressure while encouraging “evidence-based” lifestyle and adherence interventions until the goal is met. "For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve [blood pressure] control and even reduce medication needs,” the experts wrote.
However, James also cautioned that the new guidelines — presented as a flow chart — serve as no substitute for clinical judgment, with decisions about drug interventions best left to the discretion of the individual clinician. “We hope that the [flow chart] will facilitate implementation and be useful to busy clinicians,” James said in a statement. “The strong evidence base of this report should inform quality measures for the treatment of patients with hypertension.”
Co-author Suzanne Oparil, a medical professor at the University of Alabama, Birmingham, emphasized the AMA doesn’t recommend people stop taking their blood pressure medications, given chances of serious side effects with the abrupt cessation of such drugs.
The AMA group said the new recommendations draw heavily from randomized controlled trials, and seek to establish a standard blood pressure treatment across demographic populations — unless good evidence compels them to do otherwise. Importantly, the group declined to define “high blood pressure” for any individual or group, asserting that people within the 140/90 range may benefit most from lifestyle changes, as opposed to medications.
Yet some prominent doctors disagree with the new recommendations. Elliot Antman, the president-elect of the American Heart Association, told USA Today he worries the new guidelines might leave some patients with untreated but serious high blood pressure, leaving them at risk for related health problems. Indeed, treatment for hypertension remains an opportunity for improvement in the American medical system. Only half of adults with hypertension take measures to control the condition.
Source: James, PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT. 2014 Evidence-Based Guideline For The Management Of High Blood Pressure In Adults. JAMA. 2013.