New guidelines for hypertension
This winter, a scientific hypertension guideline group, decided that we oldsters, over 60, could have a higher blood pressure than previously recommended. Previously, adults were told to have a blood pressure below 140/90 and ideally, near the norm of 120/80. But now, according to this organization, we can safely have a blood pressure of 149/90 or below. A recent article in The New York Times (December 18, 2013) reviewed these new guidelines.
Phew! This is good news for me (I hope). I was diagnosed with borderline high blood pressure when I was 50 (that’s when I started to have health problems I never
had before). My blood pressure was mostly around140/90. If you do show up at your doctor’s office with higher than normal blood pressure, your provider will likely suggest that you take your blood pressure at home, at work, and at different times of the day and week. Many of us suffer from “white coat” syndrome, where our blood pressure spikes when we visit our primary care providers! Like most adults, I wasn’t too enthusiastic about going on medication. I did try acupuncture for several months, which helped right after the visit, but then it would go up again. Because I have a lot of heart disease in my family, I didn’t want to fool around. So I listened to my doctor and went on an inexpensive medication, Lisinopril, an ACE inhibitor, which did the trick. And, I didn’t have any side effects. I was happy. But when I hit 60, my blood pressure started migrating up again, and I have to admit, I was bummed out about it. I didn’t like the idea that I would have to take more medication.
While high blood pressure can be a common risk factor for middle-aged adults, it is often undiagnosed in individuals who don’t go to the doctor for regular check-ups. Frequently, high blood pressure doesn’t cause any symptoms that the adult feels, unless their blood pressure is very high.
But I am a good patient, and I listened to my doctor, whom I have great faith in. I am happy to say that I am doing fine. But these changes can be confusing for providers and patients alike. It seems to be a regular thing lately that long held beliefs are later found to be incorrect. Sometimes, it can result in patients having less confidence in medical care.
But change that comes from more rigorous scientific inquiry is positive. It enables us to modify beliefs that were based on past research. The scientists who made this new recommendation noted that blood pressure medications could themselves cause problems in older adults that can be thorny. So, they wanted to balance the benefits of lower blood pressures, based on available research data, with the potential costs of side effects.
These new recommendations may impact the care of over 7 million Americans over 60 who have blood pressures in the newly defined safe range, which is from 140/90 to 149/90. Close to 4 million of that group are already taking medications, but still have pressures above 140/90. With the old guidelines, they might receive more or different medications, but now that is no longer recommended.
So what should adults over 60 do who have high blood pressure? Dr. James Lee, an internist at The Everett Clinic at Mill Creek suggests that these new guidelines provide adults with an opportunity to discuss the pros and cons of their treatment regimen for high blood pressure with their primary care provider. At the end of the day, your provider and you have to customize these new guidelines to your particular health care history.
What do you think about these new guidelines?