People over 60 can now have a blood pressure of 150/90 before starting treatment. The goal had long been 140/90.
For people younger than 60 with high blood pressure, there is insufficient evidence for a systolic goal because the panel who put the new guidelines together could not find rigorous studies that established systolic blood pressure goals for younger people.
Therefore normal for people under 60 remains 140/90. “The mantra of blood pressure experts in the past has been that lower is better,” Dr. Oparil said. “Recent studies don’t seem to support that.”
Until now, people were told to strive for blood pressures below 140/90, with some taking multiple drugs to achieve that goal. But the guidelines committee, which spent five years reviewing evidence, concluded that the goal for people over 60 should be a systolic pressure of less than 150. And the diastolic goal should remain less than 90.
Systolic blood pressure, the top number, indicates the pressure on blood vessels when the heart contracts. Diastolic, the bottom number, refers to pressure on blood vessels when the heart relaxes between beats.
The committee, composed of 17 academics, determined that there was not strong evidence for the blood pressure targets that had been guiding treatment, and that there were risks associated with the medications used to bring pressures down.
The committee was tasked with updating guidelines last re-examined a decade ago. Their report was published in the Journal of the American Medical Association.
Hypertension experts said they did not have a precise figure on how many people would be affected by the new guidelines. But Dr. William B. White, the president of the American Society of Hypertension, said it was “a huge number for sure.” He estimated that millions of people over 60 had blood pressures between 140 and 150. Dr. Paul A. James, the chairman of the department of family medicine at the University of Iowa and co-chairman of the guidelines committee, said, “If you get patients’ blood pressure below 150, I believe you are doing as well as can be done based on scientific evidence.”
“We have this notion that if we can get blood pressure to normal, we will have the most health benefits,” Dr. James said. “That’s not necessarily true.”
For more, read the high blood pressure special chiropractic report.
Reference: JAMA doi:10.1001/jama.2013.284427