Monday, February 6, 2017

Medical Groups Raise Blood Pressure Rx Threshold for Healthy Adults Over 60

Two leading medical organizations are recommending a less aggressive target for the treatment of high blood pressure in adults 60 and older who are otherwise healthy.

Traditionally, the threshold for high blood pressure has been set at 140 mmHg systolic blood pressure (the top number in a reading). But the new guideline says doctors should now begin treatment when adults 60 and older have persistent systolic blood pressure that’s at or above 150 mmHg, to reduce their risk of heart problems, stoke and death.

A less aggressive target like this offers a suitable balance of benefits and potential harms for these patients, according to the new guideline from the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

Any additional benefit from more aggressive treatment is small, the group say. Doctors specializing in the cardiac care of older patients said the new guidelines may be warranted.

“Several recent studies have suggested that tighter control of blood pressure in healthy older adults may produce more harm than good,” resulting in events such as too-low blood pressure or fainting, said Dr. Gisele Wolf-Klein. She directs geriatric education at Northwell Health in Great Neck, N.Y.

Dr. Kevin Marzo is chief of cardiology at Winthrop University Hospital in Mineola, N.Y. He noted that “more than half of the population over the age of 60 have hypertension. When under-treated, the risk of serious cardiovascular problems such as stroke, heart attack and heart failure increases. A lower goal of under 140mmHg may be preferred for adults with known cardiovascular disease.”

The guidelines were published Jan. 16 in the Annals of Internal Medicine and the Annals of Family Medicine.

My Take:
This is a good shift in the guidelines. Once hypertensive medications are introduced, they are seldom discontinued. They are the beginning of a cascade that adds additional medications until polypharmacy is reached.

You start with a beta blocker, calcium channel blocker, and/or ace inhibitor. This lowers blood pressure but ultimately creates edema in the legs. So now a diuretic is added, but the diuretic lowers potassium, so the doctor adds a prescription for potassium. However, that irritates the digestive tract and a PPI (proton pump inhibitor) is introduced. Finally, the patient feels so bad that an antidepressant and a sleep aid are thrown into the mix.

The average American, over the age of 60, takes 4.8 prescription drugs each day. That’s just under the definition of polypharmacy at 5 drugs per day. I frequently see older patients taking 10, 12, or even 16 prescription drugs daily.

Bottom Line:
Talk to your PCP about reducing your meds. You can start by monitoring your blood pressure and presenting this data to your doctor.

Source: January 16, 2017 National Institutes of Health

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