AHA president concerned by new blood pressure treatment guideline

A new guideline published Monday recommends less-aggressive blood pressure treatment for many people, guidance the American Heart Association’s president said could actually increase their risk for major health problems.

The guideline from the American College of Physicians and the American Academy of Family Physicians, published in the Annals of Internal Medicine, recommends that people 60 and over who have no history of cardiovascular disease shouldn’t be treated for hypertension unless their blood pressure is persistently at or above 150/90.

The American Heart Association, along with the American College of Cardiology and the Centers for Disease Control and Prevention, consider people to have high blood pressure at 140/90 or higher. The health organizations advise lifestyle improvements such as a healthy diet, exercise and maintaining an appropriate weight, and then adding medication if needed to bring the blood pressure down to less than 140/90. At age 80, treatment at 150/90 may be considered, the organizations said.

Proper treatment is critical because one in three American adults — about 80 million — have high blood pressure, which increases the risk for stroke, heart attack, heart failure and other serious health issues.

AHA President Dr. Steven Houser said there are many positive aspects of the new guideline, including emphasis of the importance of high blood pressure as a risk factor, encouragement of careful blood pressure measurement, the value of positive lifestyle changes and treating to a target of lower than 140/90 for patients 60 and older who have a history of stroke or transient ischemic attack, to lower their risk of recurrent stroke, and for those 60 and older who are at high cardiovascular risk.

“However, we are concerned that this review does not take into account the extensive body of evidence supporting the benefit of adequate blood pressure control in other patients with hypertension, especially in the prevention of heart failure and stroke, both outcomes that greatly reduce patients’ quality of life,” said Houser, who is the Director of the Cardiovascular Research Center, Professor of medicine and Professor and Chair of Physiology at Temple University School of Medicine.

The AHA, American College of Cardiology, and Centers for Disease Control and Prevention all consider treating blood pressure at 140/90 to be a major way to reduce the risk of cardiovascular events, especially stroke.

Authors of the new guideline questioned whether that’s necessary.

“The evidence showed that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes,” said American College of Physicians President Nitin S. Damle, M.D.

In addition to his concerns about medical risk, Houser warned that relaxing blood pressure targets without sufficient evidence could create a false sense of security for some people who need to understand that high blood pressure is dangerous but can be controlled.

“We hope all individuals will work with their healthcare providers to ensure healthier, longer lives for everyone,” Houser said. “With the recent suggestion of a slowing in the decades-long, steady decrease in death rates, we just can’t afford to back off on our efforts to control this major risk factor.”

The president of the ACC, Richard A. Chazal, M.D., FACC, agreed about the importance of awareness.

“Attention to the management of hypertension is essential,” he said. “There continues to be debate over the optimal treatment goals for high blood pressure in patients over the age of 60, but a multi-disciplinary writing panel led by the ACC and the AHA is finalizing a comprehensive new guideline for the management of hypertension that will be released later this year.

Other organizations working on the panel include the American Academy of Physician Assistants, the Association of Black Cardiologists, the American College of Preventative Medicine, the American Geriatric Society, the American Pharmacist Association, the American Society of Hypertension, the National Medical Association, and the Preventative Cardiovascular Nursing Association.

“In addition to careful and thorough review of the latest research and science around hypertension management, the writing panel will also take into consideration these new guideline recommendations,” Chazal said. 

Editor’s Note: This story was written when high blood pressure was considered 140/90 or higher. New guidelines released in November 2017 changed the definition to 130/80.