New Blood Pressure, Cholesterol Guidelines Spur Debate

blood pressure

New blood pressure guidelines puts many out of the population at risk. But that does not mean you should not treat your BP lightly.

According to JAMA, applying the updated 2014 blood pressure (BP) guideline to the U.S. population suggests that nearly 6 million adults are no longer classified as needing hypertension medication, and that an estimated 13.5 million adults would now be considered as having achieved goal blood pressure, primarily older adults. Ann Marie Navar-Boggan, M.D., Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues quantified the proportion of adults potentially affected by the updated 2014 recommendations, compared to the previous guideline, issued nearly 10 years ago. The researchers used data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010 and evaluated hypertension control and treatment recommendations for U.S. adults. The new guideline proposed less restrictive BP targets for adults 60 years of age or older and for those with diabetes and chronic kidney disease. The authors estimate that the proportion of younger adults (18-59 years) in the U.S. considered to have treatment-eligible hypertension would be decreased from 20.3 percent to 19.2 percent under the 2014 BP guideline and from 68.9 percent to 61.2 percent among older adults (‰ä´ 60 years). Extrapolating these numbers translate to a reduction in 5.8 million adults no longer classified as needing hypertension medication. The authors estimate that 13.5 million adults not previously considered to be meeting BP targets would be considered at goal BP under the new guideline, with the majority affected age 60 years and older, many of whom have diabetes, chronic kidney disease, and cardiovascular disease. ‰ÛÏPublic health messaging should target the large number of adults in the United States with changing recommendations under new guideline to ensure that new recommendations do not result in unintended consequences in adults now with ‰Û÷relabeled‰Ûª BP status,‰Û the authors write. Statin Use Differs in U.S. versus Europe Another JAMA study shows that U.S., European Cholesterol Guidelines differ in statin use recommendations. Application of U.S. and European cholesterol guidelines to a European population found that proportions of individuals eligible for statins differed substantially, with one U.S. guideline recommending statins for nearly all men and two-thirds of women, proportions exceeding those of the other guidelines. Cardiovascular disease (CVD) primary prevention guidelines developed by the National Cholesterol Education Program expert panel, the American College of Cardiology/American Heart Association (ACC/AHA) task force, and the European Society of Cardiology (ESC) are the major guidelines influencing clinical practice. The researchers found that application of the ACC/AHA guideline recommended treatment would apply to 96.4 percent of men and 65.8 percent of women; for the expert panel guideline, the portion was 52 percent of men and 35.5 percent of women; and for the ESC guideline, 66.1 percent of men and 39.1 percent of women were included in the category where treatment was recommended. With the ACC/AHA approach, average predicted risk vs observed major events was 21.5 percent vs 12.7 percent for men and 11.6 percent vs 7.9 percent for women.åÊ Similar overestimation occurred with the other models. Simply stated, we are over estimating both the need for statins and the actual risk of the population for adverse cardiovascular events. For you that means questioning your physician. We still over medicate in this country, partially to protect from lawsuits and I would think partially because of the enormous sway of the drug industry.