Members appointed to the Eighth Joint National Committee have released new guidelines for managing high blood pressure, including nine recommendations and a flow chart to help doctors treat patients with hypertension.
Published online in JAMA, the guidelines address three major questions related to hypertension – the most common primary care condition, which can lead to heart attack, stroke, kidney failure and death.
In a linked editorial to the guidelines, Dr. Howard Bauchner, editor in chief of JAMA, notes that creating guidelines in the US “has become increasingly more complicated and contentious,” due to stakeholder beliefs.
However, the committee members set out to address the following three questions:
- In patients with hypertension, at what blood pressure should medication be started?
- What blood pressure goal should patients aim for in order to know they are getting health benefits from their meds?
- When beginning treatment for hypertension, what are the best medication choices?
After pulling evidence from randomized controlled trials, the investigators concluded that patients 60-years-old or more with hypertension should aim for a blood pressure level of less than 150/90 mm Hg.
Additionally, they found that people aged 30-59 should aim for a diastolic goal of less than 90 mm Hg, but they also add that there is not enough evidence to set a systolic goal in hypertensive patients younger than 60-years-old.
As a result, the committee recommends a blood pressure of less than 140/90 mm Hg for those groups.
“The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years,” the panel adds.
Rather than defining at which blood pressure (BP) level hypertension begins, the committee members identify “threshold blood pressure” levels at which treatment can begin.
They suggest beginning treatment in patients aged 60 and older at a blood pressure of 150/90 mm HG, but they note that “this evidence-based guideline has not redefined high BP and the panel believes that the 140/90 mm Hg definition from Joint National Committee 7 remains reasonable.”
However, they also emphasize the benefits of a healthy diet, weight control and regular exercise, which they say “have the potential to improve BP control and even reduce medication needs.”
The committee members conclude their guidelines by adding:
“However, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.”
In July 2013, Medical News Today reported on a study suggesting that new molecules could be used as a starting point for developing drugs that “switch off” high blood pressure in the body, while another study suggested that vitamin D can help prevent hypertension.