Higher blood pressure threshold OK in older adults
CHICAGO - Many older adults with high blood pressure can be treated less aggressively, which could mean taking fewer pills to get it under control, according to new treatment guidelines from an expert panel. But not all experts are on board with the advice - including the federal agency that appointed the group.
CHICAGO - Many older adults with high blood pressure can be treated less aggressively, which could mean taking fewer pills to get it under control, according to new treatment guidelines from an expert panel. But not all experts are on board with the advice - including the federal agency that appointed the group.
Panel members stressed that they were not changing the definition of high blood pressure: 140 over 90. For adults aged 60 and older, they are recommending a higher treatment threshold, prescribing medicine only when levels reach 150 over 90 or higher.
Overly aggressive treatment can cause fainting and falls in older patients, or bad interactions with drugs they are taking for other illnesses, panel members said.
The panel does endorse the lower target of 140 over 90 for younger adults - and for all adults with diabetes or kidney disease.
Two drugs or more
The guidelines released Wednesday are based on a review of the most rigorous kind of research - studies in which patients are randomly prescribed drugs or dummy pills - published since the last update in 2003. The research suggests older patients can avoid major problems like heart attacks, strokes, and kidney disease even when their blood pressure is above the current recommended level, the panel said.
For many patients, two or three drugs - or more - are needed to bring their blood pressure down. Many older adults could probably reduce their doses, or take fewer drugs, to reach the new, less strict target, said Paul James, a panel member and family-medicine specialist-researcher at the University of Iowa.
Updates in 2014
While the guidelines were updated by a government-appointed panel, they don't have the government's endorsement. The panel completed its work earlier this year, around the time the National Heart, Lung and Blood Institute announced it was getting out of the guidelines business and turning the job over to the American Heart Association and American College of Cardiology. Updated guidelines from those groups are expected in late 2014.
In the meantime, the heart association is raising concerns about the new recommendations, saying that many studies they are based on didn't last long enough to reveal dangers of undertreated high blood pressure in older patients.
Gary Gibbons, director of the federal Heart, Lung, and Blood Institute, issued a statement emphasizing that his agency has not sanctioned the panel's report, nor has the broader National Institutes of Health.
The panel said that its guidelines were simply recommendations and that doctors should make treatment decisions based on patients' individual circumstances.