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 New Threshold for Hypertension Widens Risk Pool

A new guideline for the management of high blood pressure (BP) lowers the threshold for a diagnosis of stage one hypertension, expanding the number of people who now fall under that classification. The guideline examines a broad range of topics, including lifestyle management strategies for both prevention and treatment.

The guideline, issued by the American College of Cardiology and the American Heart Association, appears in the November issue of the Journal of the American Medical Association.

The guideline defines stage one hypertension as any systolic BP measurement of 130 mm Hg or higher, or any diastolic BP measurement of 80 mm Hg or higher (130/80 mm Hg). The previous guideline classified hypertension as a BP reading of 140/90 mm Hg or higher, which now denotes stage two under the new guideline.

The definition significantly increases the number of individuals with a hypertension diagnosis, clinicians say. The new guideline uses a uniform definition for elevated blood pressure and hypertension for all individuals, without regard to patient age or comorbid illness.

Residents and patients in long term and post-acute care centers are particularly affected by the extended classification, says Karl Steinberg, MD, chief medical officer for Mariner Health Central and medical director of Life Care Center of Vista and Carlsbad by the Sea Care Center in Carlsbad, Calif.

“Even using the traditional criteria for hypertension, well over half our post-acute and long term care patients have that diagnosis,” he says. “The new criteria will increase the numbers further.” 

In the geriatric population, says Steinberg, it’s preferred to use medication only if necessary. “And the decision whether to use blood pressure medication should always be individualized to each patient's risk factors, potential burdens and benefits of treatment, and their goals of care,” he says.

According to the guideline, recent randomized clinical trials as well as observational and modeling studies support the lower treatment thresholds as beneficial to higher-risk patients. In addition, the risk-based treatment approach of the guideline is consistent with recent cholesterol guidelines.

Reflecting on the changes in the guideline, Steinberg says that, while providers have historically been tolerant of higher blood pressure in elderly patients, current research points out benefits of maintaining it at a certain level.

“Recent research has demonstrated that shooting for a target systolic of around 130 with usual bedside measurement is probably preferable if side effects from often multiple medications are not problematic,” he says. “This does seem to lower the risk of cardiovascular events, even in the frail elder population with limited life expectancy.”

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