Minority Report: Five Guideline Authors Reject Change in Systolic Blood Pressure Goal — Physician’s First Watch

Medical News |
January 14, 2014

Minority Report: Five Guideline Authors Reject Change in Systolic Blood Pressure Goal

By Larry Husten

Five of the 17 authors of the new hypertension guidelines from the Eighth Joint National Committee (JNC 8) disagree with the new systolic blood pressure target of 150 mm Hg or below for adults aged 60 and older. Previously, the target was 140 mm Hg.

Writing in the Annals of Internal Medicine, the authors argue that the evidence was insufficient to support the change. In addition, 82% of older adults with hypertension are receiving treatment, and the median systolic blood pressure of those being treated is 136 mm Hg. "If we go to the higher blood pressure target, that would mean potentially backing off on therapy in over half of the patients who are already below 140," one of the dissenters said in an interview.

The authors also note that the revised goal could reverse gains in public health, as both coronary heart disease and stroke mortality have declined as blood pressure has declined. Finally, they say a target of 140 mm Hg would be consistent with guidelines from Europe, Canada, the American College of Cardiology Foundation/American Heart Association, and the American Society of Hypertension/International Society of Hypertension.

Editors' note: Adapted with permission from CardioExchange.

Reader Comments (7)

ANIL CHAWLA Physician, Hospital Medicine, India

It really is absurd to change the control level to a higher level officially. As it is, most people's Blood pressures are not adequately controlled. If a BP level of 140 was producing symptoms of giddiness or ill health in any other way, then only the change to a higher level was to be acceptable. But 140 doesn't.

Shivinder Singh MBBS,MD Physician, Critical Care Medicine, Teaching Hospital

Many times trying to achieve a very tight blood pressure control in patients above 60 results in weakness/ syncopal episodes . Therefore, from intuitive clinical experience in patients in their 80s and 90s I would think the figure of 150 is justified.

Vince Miraglia Other, Other

Since the group was ripe with members with conflicts of interest one could only hope that the demand for less drugs and the resultant less pharma sales was not a consideration...

Sheldon Ball MD, PhD Physician, Geriatrics, Anvita Health

There is considerable evidence to suggest a goal of systolic blood pressure in patients > 80 years of age should be even higher than 150 mm Hg. See clinical trials section for 'blood pressure in the very old' at http://www.anvita.info/wiki/Blood_Pressure_In_The_Very_Old.

Thomas Harrison, MD Other, Ophthalmology, Retired

Read the column every morning. Thank you. TJH

Michae Bone BSc MB DCH FRCP Physician, Hospital Medicine, South Tyneside NhS Foundation Trust
Competing Interests: A still practising General Physician. And proud of it!

Guidelines are Guidelines and just that! They are not absolute protocols and need to be adapted to each individual. I have numerous patients (>80) who cannot tolerate SBPs of 140, although that is my aim. 1or 2 falls, a hospital admission, # neck of femur and there goes your independence and autonomy. What price in overall QoL for an extra few months? Talk and discuss these issues with each and every patient and their nearest and dearest. That's the answer!
From the last of the dinosaurs

Jennifer Carlquist PA-C Other Healthcare Professional, Cardiology

I couldn't agree more!! Well said.

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