Note the increased number of cases of hypertension if the 2017 cut-offs are used.
Paul Goldfinger, MD, FACC. Editor @Blogfinger
Here is a link to our post last year about the new 2017 guidelines. This is the most recent information available in terms of guidelines for diagnosis and treatment.
2017 blood pressure guideline update on Blogfinger
In 2015 the SPRINT Trial appeared, but it provided more aggressive treatment than many doctors would accept.
And below is a link to the JNC 8 guidelines of 2013.
2013 JNC 8 blood pressure guidelines. Review in Blogfinger
For those of you with an active interest in the topic of hypertension, you would do well reviewing the BF posts linked above to appreciate that doctors may disagree about guidelines.
All these guidelines come together now in 2018 as doctors try to figure out what method is best and how to resolve discrepant results.
Currently physicians are trying to come up with a lucid and uniform approach to diagnosing and treating hypertension. Below are some of our conclusions at the Blogfinger Off-Shore Medical School in Ocean Grove, NJ.
a. The 2017 guidelines found that following that cutoff (130/80) reduces risk of stroke and cardiovascular complications if the target readings are achieved, but that can be difficult. We think that the 2017 guidelines, applied carefully to patient care, would be best.
But some major physician groups (eg the American Association of Family Practice) say that for those over age 60, this cutoff is too dangerous and for that group, the cutoff should be 150 mm Hg systolic. But if the patient is high risk (eg someone who has had a heart attack) a cutoff of 140 would be best. They are using the 2013 JNC 8 recommendations.
b. Most medical groups have embraced the new 2017 guidelines.
c. This is not a trivial issue because with the 2017 guidelines for diagnosis, 45% of the US population would be considered to be hypertensive. But the more people who are placed on drug therapy, the more people will show up with complications such as hypotension (excessively low BP) which can result in falling (with injuries,) dizzy spells, fainting, and kidney problems.
d. It seems to me that the 2017 guidelines make sense and will produce better outcomes than the less aggressive cutoffs that existed for many years. Unless all the doctors get it together and agree, there will be a sort of free for-all with individual physicians deciding on their own. Hopefully the smoke will clear and most physicians will be on board.
But what is clear, and I suspect most doctors will agree, we do need to lower BP readings more than in the past, and we do need to diagnose hypertension at lower cutoffs than the past.
e. Finally, patients should follow medical advice which should include preventive measures (diet, weight, exercise, etc.) and usually medication. Regarding the latter, oftentimes combination therapy of 2-4 different drugs may be required to achieve the desired cutoff. Such combinations allow individual drugs to be used at safer lower doses.
Hypertension is the “silent killer,” so follow good medical advice and participate in your care with home BP monitoring and adherence to medical regimens even if you feel fine. That is the essence of prevention.
f. Ask your doctor about his targeted plan for you. Make sure that you are not a therapeutic failure. Know your target reading and keep a written record.
And, to cheer you up, here is Jerry Seinfeld in the drugstore:
Being a nurse, I read a lot of articles for hypertension and found this one https://www.madeformedical.com/nursing-care-plan-for-hypertension/ but then I read your article. You added a lot to my knowledge. Thank you!
Another issue relates to the accuracy of readings, wherever they are obtained. Here is a quote from one of our BF posts on hypertension”
“In the office, the BP reading is often taken in a hurry by a medical assistant whose technique is often sloppy using untrustworthy equipment. In addition, a rushed measurement is often misleading. The patient should be allowed to sit quietly and then repeat the reading. The doctor should double check it himself.”
There is a condition called “masked hypertension” where the BP readings are normal in the doctor’s office, but if home readings are done and reveal elevations, then those readings should be treated.
A very good test to most accurately evaluate a patients BP variations is the 24 hour BP monitor. It can give the physician a lot more information than the random method currently in use. I’m told that insurance companies would pay for this test, although they refused in the past. An example of this is when someone has “morning hypertension” with more normal readings at other times. Based on that info, the physician may be able to tailor therapy by timing medications accordingly. The same applies to nocturnal hypertension.—–PG
Some doctors and patients believe that a high BP reading in a doctor’s office is just an artifact due to stress and can be ignored. But the research trials show a risk even if your BP is elevated only in the office (“white coat hypertension,”) and treatment may be required for that.—-PG