By Paul Goldfinger, MD, FACC.
After the JNC 8 guidelines were finally released in 2013, I began a series of articles about hypertension (high blood pressure) because it is such a common condition, and there has been confusion as to how to treat the problem. Experts on the subject sometimes differ based on a variety of clinical trials, and your doctors may give you conflicting information. Please look at the 3 links below and then drop down to our latest summary.
Background on high blood pressure
Misc high blood pressure topics
2017 BF discussion on hypertension treatment in older patients
In June 2017, a huge analysis of multiple trials of hypertension patients “reports that risk of cardiovascular disease and mortality was much lower in patients who attained a target systolic blood pressure (that’s the top number) below current recommendations.” (Medscape June 21, 2017)
They looked at 42 randomized clinical trials and more than 140,000 patients. The work was led by a team from the SPRINT trial at Tulane University in New Orleans.
Most doctors have tried to lower systolic readings below 140 mm Hg. But this study says that the lowest risk was at a systolic BP of 120-124 mm Hg. At the least, the authors suggest that physicians get BP readings below 130 mm Hg, if that goal can be safely achieved.
A big problem is that even with a goal of 140 mm Hg, doctors are not doing well in getting their patients there. The lead author in the SPRINT trial said, “I think 130 mm Hg is a reasonable goal.” But he also said that their published paper in Circulation in 2016 showed that “worldwide, using 140 mm Hg as the cut point, only 17% of hypertensive patients have their blood pressure controlled. At a much lower goal of 125 mm Hg, uncontrolled blood pressure would be “huge.”
As a cardiologist who followed the idea of “evidence based practice” I pushed to achieve the guideline goals in my patients and achieved success in nearly 100%. It is doable if the doctor and the patient form a partnership and are strongly motivated to get to target readings. Some of my own ideas are reviewed in the links above.
Meanwhile if you have hypertension be sure to get a home BP device and follow my suggestions above. I am not exaggerating when I tell you that hypertension can be successfully treated with few side effects and that such therapy can prevent complications like strokes and heart attacks and can reduce death rates. If you must be fearful, be afraid of the disease and not the therapy.
As newer studies and guidelines emerge, I will keep you all informed.
MUSIC Why? Music can be therapeutic. Stress reduction can lower your blood pressure.
ALICIA MORTON with some encouraging words from Annie: