Tuesday 30 Sep 2014

Information and opinions presented here do not always represent the views of the American Heart Association.

Study questions proposed blood pressure guidelines in people 60 and older

Published: 3:00 pm CDT, August 18, 2014

A new study is raising questions about treatment guidelines proposed by a health panel last year that had recommended changing blood pressure targets for coronary artery disease patients age 60 and older.

The study published Monday in the Journal of the American College of Cardiology found that patients who lowered their systolic blood pressure below 140/90 millimeters of mercury or higher reduced their risk of heart attack, stroke and premature death more than patients who maintained a systolic blood pressure between 140/90 and 150/90.

That finding contrasts with a report published last year in the Journal of the American Medical Association.

The report published in JAMA said healthcare providers should take a new approach to treating high blood pressure for people 60 and older. The panel advised treatment at 140/90 for adults from ages 30 to 59, but starting only at 150/90 for people 60 and older.

In a joint statement Monday, American Heart Association President Elliot Antman, M.D., and American College of Cardiology President Patrick O’Gara, M.D., said the new research affirmed their concern over the panel’s recommendations.

“Raising the threshold for treatment of hypertension in patients 60 years of age or older with coronary artery disease may be detrimental to the best interest of patients and the public,” they said. “ACC and AHA, working with the National Heart, Lung and Blood Institute, are in the process of assembling the writing panel that will evaluate evidence from a variety of sources and provide a comprehensive update of the hypertension guidelines.”

According to the American Heart Association, one in three American adults have high blood pressure – which is defined as a reading of 140/90 or higher — putting them at an increased risk for heart attack, stroke and other cardiovascular complications.

Monday’s study analyzed 8,354 patients age 60 and older with established coronary artery disease. It found that 57 percent of them had systolic blood pressure below 140/90. Another 21 percent were between 140/90 and 150/90, and 24 percent had a systolic blood pressure of 150/90 or higher.

According to lead researcher Sripal Bangalore, M.D., Director of Research, Cardiac Catheterization Laboratory at New York University School of Medicine in New York City, patients with readings between 140/90 and 150/90 had slightly higher rates of cardiovascular complications, such as stroke and heart attack, as well as an increased risk of premature death compared with those who had achieved a blood pressure of 140 or lower.

The changes recommended in the JAMA report also caused disagreement among the original writing group, with five of the 17 writing group members openly rejecting the new target recommendations and suggesting that such a proposal could place patients at risk and harm public health, including minorities and patients with risk factors, such as diabetes.

The American Heart Association and the American College of Cardiology released four cardiovascular treatment guidelines for healthcare providers in November 2013, and their high blood pressure guidelines are expected to be updated in 2015.

Until then, the American Heart Association and the American College of Cardiology recognize the most recent hypertension guidelines, published in 2004 by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, as the national standard.

Talking to your doctor or other healthcare provider about the best treatment plan for your high blood pressure is key.

The American Heart Association, the American College of Cardiology and the U.S. Centers for Disease Control and Prevention published a simple approach for clinicians to use to safely control high blood pressure. This approach was developed by an expert panel and contains a treatment algorithm or flow chart to help doctors treat patients with hypertension.