NIH Issues New Blood Pressure Medication Guidelines
December 18, 2013

NIH Issues New Blood Pressure Medication Guidelines

Brett Smith for – Your Universe Online

A new set of recommendations for treating high blood pressure released by an expert panel has essentially called for less people to receive prescribed medications.

Formed under the National Institutes of Health, the Eighth Joint National Committee has published an update to the last set of high blood pressure guidelines in the Journal of the American Medical Association. The last set of recommendations was issued in 2003.

According to the new guidelines, adults who are 60 or older should only be prescribed treatment medication if their blood pressure is above 150/90, which is higher than previous guideline of 140/90.

The panel also looked at gaps in treatment guidelines for systolic, or exerting, pressure and diastolic, or resting, pressure.

“There is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion,” the panel wrote. “The same thresholds and goals are recommended for hypertensive adults with diabetes or non-diabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years” – a change from the previous blood pressure threshold of 130/80 mm Hg for persons with the conditions.

According to guidelines author Dr. Paul James, head of the department of family medicine at the University of Iowa, the recommendations are based on evidence showing how the more stringent guidelines provided no additional benefit to patient outcomes.

"We really couldn't see additional health benefits by driving blood pressure lower than 150 in people over 60 [years of age]," James told HealthDay. "It was very clear that 150 was the best number."

In November, the American Heart Association released its own guidelines and AHA president-elect Dr. Elliott Antman expressed doubts about the panel’s conclusions.

"We are concerned that relaxing the recommendations may expose more persons to the problem of inadequately controlled blood pressure," he said.

James said the panel’s idea of a higher blood pressure threshold for placing seniors on medication is based on evidence, concern over possible drug interactions and high drug costs.

"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?"

Patients who have high blood pressure readings that fall below the panel’s threshold should be treated through lifestyle changes, according to James. For cases where medications are deemed necessary, the panel recommended four different blood pressure drugs – 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 (the previous guidelines), 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.

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