The new blood pressure guidelines have not been universally accepted because the evidence for the benefits of treating mild hypertension and those individuals without established cardiovascular disease is less certain. So far, the American College
of Physicians and the American Academy of Family Physicians are not changing
their goals for people over age 60: SBP of 150 for those at average or low cardiovascular
risk and a SBP target of 140 for those at high CVD risk.
It is not surprising that the latest guidelines on hypertension have not ended the
controversies relating to blood pressure diagnosis and treatment goals. Writing in
the JAMA prior to the release of the 2017 guidelines, Aram Chobanian noted that
setting blood pressure goals is not an exact science. More than 75% of persons
aged 75 or older have hypertension, and the reduction of SBP is clearly beneficial,
but the exact SBP goal is still unclear.
The authors of one study concluded that their findings contradict the commonly
held “lower is better” hypothesis, and that their findings support the recommendation
to treat persons without cardiovascular disease who have a systolic blood
pressure above approximately 140 mm Hg, but treatment would not be of benefit
and may be even harmful in persons with lower systolic blood pressure levels.
Evidence about the lack of benefits of intensive lowering of BP among the elderly
comes from a randomized, controlled study, ACCORD. It found no significant
difference in the primary outcome (nonfatal myocardial infarction, nonfatal stroke,
or death from cardiovascular causes) between the intensive care (SBP less than 120
mm Hg) and the standard care (SBP less than 140 mm Hg) treatment groups. There
was an increased risk of adverse events in the group targeting SBP to less than 120 mm Hg (including elevations in serum creatinine and electrolyte abnormalities). However, the intensive care group did have a 40% decreased stroke incidence, and
there was a nonsignificant reduction in CVD events.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel