New BP Guidelines Questioned
On December 19th 2013, ThirdAge.com reported on the new hypertension guidelines from The American Society of Hypertension Inc. and the International Society of Hypertension. The revised recommendation was150/90 for people 60+ before starting treatment, up from the recommendation of 140/80 that has been the standard for 30 years. Now the panel members who voted against raising systolic blood pressure targets are speaking out against the decision to raise the threshold at which older adults begin taking medication to control their blood pressure.
In a commentary published in the January 14th 2014 issue of the journal Annals of Internal Medicine, members of the Institute of Medicine's Eighth Joint National Committee explain why they voted against relaxing systolic blood pressure targets to 150 mmHg for patients aged 60 and older without diabetes or chronic kidney disease. A release from the American College of Physicians notes that opposing panel members submitted the editorial because they say published guidelines did not adequately explain their concerns. They argue that evidence for raising the systolic blood pressure target was insufficient and that doing so will likely reduce the intensity of antihypertensive treatment in a large population of people at high risk for cardiovascular disease, potentially reversing the decades long decline in CVD, especially stroke mortality.
In a summary of the article, the authors wrote: “The guideline panel was faced with a lack of definitive RCT [randomized controlled trials] evidence to determine the optimum SBP [systolic blood pressure]. . . [T]he panel did not reach unanimous consensus on the recommendation for persons older than 60 years who do not have DM [diabetes mellitus] or CKD [chronic kidney disease]. . . We, the panel minority, believed that evidence was insufficient to increase the SBP goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for CVD [cardiovascular disease] and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years . . . However, we did believe that an SBP goal of less than 150 mm Hg for frail persons aged 80 years or older was a reasonable alternate approach to addressing the concern that elderly patients are at higher risk for treatment-related serious events. A target SBP of less than 140 mm Hg for patients younger than 80 years would also be in line with guidelines from Europe, Canada, the American College of Cardiology Foundation and the American Heart Association, the United, and the American Society of Hypertension and the International Society of Hypertension.”