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130/80 - New Blood Pressure Guidelines

The American Heart Association released new guidelines for high blood pressure, lowering the diagnosis to 130/80 mmHg. This benchmark will establish such diagnoses in nearly half the adult population in the United States and in about 75% of the population above the age of 50. Up to three times as many young people < 44 years of age will suddenly carry the diagnosis.

The guidelines are based on a large clinical trial (SPRINT) which reported a 25% reduction of cardiovascular events including deaths, with intensive blood pressure control to 120 over 80 mmHg over an observation period of little over three years. This sounds quite impressive. Although I am not a statistician, I looked at the absolute numbers and they are giving me a slightly more enlightening understanding of the actual impact.

So, the total number of cardiovascular events was 5.2% in the intensive treatment group versus 6.8% in the less intense group. This translates to total absolute difference of 76 patients. Considering that the trial involved close to 10,000 people, this difference is tiny and amounts to 0.8%. And these were patients without diabetes, another major cardiovascular risk factor, and no history of strokes either.

It is quite conceivable that if the trial were smaller, there would not be any statistical difference in these observations. The comparable clinical trial (ACCORD) had half the number of enrollees and did not see statistical difference in the cardiovascular outcomes. So, in my simple mind, I am a little confused, how these results made guidelines.

Nonetheless, they could significantly increase the costs of healthcare spending. The American College of Cardiology screening recommendations include a battery of laboratory tests, EKGs and possibly more sophisticated diagnostic studies like an echocardiogram. For younger patients, or who are responding poorly to medications, further, more extensive testing is recommended. I believe, that before long, attaining these blood pressure goals will become a matrix of physicians’ performance tied to outcome measures and insurance reimbursement.

In my opinion, this singular “health” goal is taken out of context of human life. Healthy lifestyle measures, as documented in the PREDIMED study with 30% reduction in cardiovascular risk and diabetes appears to be more powerful than a dogmatic rigid blood pressure goal dictated by guidelines. We have seen this problem with cholesterol goals over decades. Results of lifestyle modifications have been very modest, mainly because they are poorly structured with no financial incentives for the healthcare providers and certainly not supported by pharmaceutical industry, since a carrot is a carrot, and hard to sell on Wall Street.

I hope, that in a couple years with intensive efforts to reduce blood pressure to the new benchmark, we will not suddenly realize, that quality of life is poor, dizziness and lightheadedness, fatigue, falls, bone fractures, kidney problems and other associated side effects from various blood pressure medications will by far outweigh the currently hailed benefits. We are humans - with imperfections, after all, and medicine should remain an art of healing.

Key point to remember :

  • Uncontrolled blood pressure is a high risk for heart attacks and stokes. But just popping pills and hoping for the best, could be just as dangerous. Take charge of your health destiny and find a healthcare provider, who is willing to work with you toward reasonable goals. There a many, many non pharmacological first steps you need to take, to make a long lasting difference.

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