Controversy Rises as High Blood Pressure Guidelines Lowers

In November 2017, hypertension guidelines changed in a comprehensive resource for the clinical and public health practice communities. 

This is one of the most significant health adjustments in the past 14 years. Previously, 120/80–139/89 mm Hg was treated as pre-hypertension. Under the new guidance, 130/80 is now stage-1 hypertension. Simple rationale for such a landmark decision is to protect the health of more patients. The feeling is that pre-hypertension was not being taken seriously enough. The consequences are that nearly half of U.S. adults could now be classified with high blood pressure.

2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults
2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults, JACC.

Pharmaceutical companies must ramp up production of high blood pressure medications. Cardiologists, endocrinologists, medical groups, and insurers need to adjust internal policies, adapting to a significant increase in the number of individuals requiring care.

Why the Controversy?

Patients are expected to be the ones raising objections to additional doctor visits, prescriptions and dietary restrictions. But some doctors are balking at the guidelines. Fitting a vast population of ages, body shapes, weights, and heath conditions into one numeric goal is said to be improbable.

“Although the new guideline lowers the blood-pressure goal for people over 65, it suggests that 30-year-olds and 80-year-olds should have the same goal. Achieving that goal is impossible for many people, especially those with poor vascular compliance (i.e., pulse pressures above 80 to 90 mm Hg), who typically have dizziness and poor mentation as their systolic blood pressure approaches 140 mm Hg,” Bakris and Sorrentino wrote.

Bakris and Sorrentino concluded that, while a “target of less than 130/80 mm Hg makes sense for high-risk patients, for everyone else it seems more reasonable to continue defining hypertension as a blood pressure of 140/90 mm Hg or higher.”

On the sidelines are anatomy chart manufacturers. Hypertension, High Blood Pressure, and Cardiovascular Disease posters have been discontinued as modifications are made.

At What Stage of Compliance Are You?

Once you post guidance on your exam room wall, you need to own it. That is to say, doctors, nurses, pharmacists, accounting departments, and insurers must have physical and technical infrastructure to help patients reach these new goals.

Anatomy poster distributors are caught in the middle. Do they satisfy critics and keep producing posters based prior guidelines or alienate critics by publishing new charts? It would be helpful to hear from those affected by the new guidelines. At what stage of compliance are you or is it business as usual?

According to a Twitter poll, a little over half of respondents support new guidelines. Half of this number have initiated compliance procedures.

References
  1. High blood pressure redefined for first time in 14 years: 130 is the new high. American Heart Association, heart.org
  2. High Blood Pressure Guidelines Hub. Journal of the American College of Cardiology, onlinejacc.org
  3. Redefining Hypertension — Assessing the New Blood-Pressure Guidelines. The New England Journal of Medicine, nejm.org
  4. ACP Criticizes New Blood Pressure Guideline. MedPage Today, medpagetoday.com

 

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