Blogfinger

2003–The most current guidelines (thanks to the US Dept of Health and Human Services)

By Paul Goldfinger, MD, FACC and Dean of the Blogfinger School of Medicine  (licensed off shore on Coney Island)

In a New York Times medical article (January 28, 2013),  the writer Jane Brody interviewed a hypertension expert and author, Samuel Mann, MD,  from the Weill-Cornell Medical School.  He asserted that only 48% of the 76 million hypertensive patients in the U.S. are under control.  He also said than among the factors that result in poor control are doctors who don’t know “the intricacies and nuances” of treatment, wrong doses of medicine, wrong choice of drugs, and patients who stop their medicines, eat too much salt and don’t lose weight. But then, after blasting doctors, he said that only 10-15% of the cases which are poorly controlled actually require attention by a specialist.

Dr. Mann  said that treatment should be tailored to the specific type of high blood pressure:  kidney based, salt sensitive or “neurogenic” by which he means “due to repressed emotions.”   I think that the vast majority of doctors do not use his terminology, but he does have a point about trying to tailor treatment to the underlying mechanism of the disorder.   Finally he advocated home BP checks of which I am a big advocate.

If you look at Obamacare, it is depending on expert panels to produce guidelines for healthcare including those for prevention which focus on obesity, high blood pressure (hypertension) and cholesterol.  The National Institutes of Health are responsible for these guidelines, and the writing group, divided into sections, is called the Joint National Committee on Prevention  (JNC).

When it comes to hypertension, the JNC-7, the most recent guidelines, were released in 2003.  JNC-8 has been years in coming, but still is missing in action.  Word has it they are headed for the finish line, but we have been fooled before.

The problem with the NY Times review that describes a massive failure to control hypertension is that they are using a target value of 120/80 as the number which must be achieved.  But if you look at  JNC-7, the goal is 140/90  (or less) for most patients, and 130/80 for diabetics.  It is likely that once JNC-8 comes out, the numbers will be lowered, but that hasn’t become official yet.  So, by currently accepted criteria, the percent of “under control” patients is probably a lot higher than the 48% noted above.

In a subsequent article.  I will bring you up-to-date regarding the factors that prevent good control and I will review the life-style methods that can produce significant improvements in blood pressure lowering without drugs. Some of Dr. Mann’s remarks will be addressed as well.

Which will occur first,  the JNC-8 recommendations or the Goldfinger guidelines?  Stay tuned.