New
Pressure to Lower Blood Pressure
Cardiovascular
disease is a serious problem in the United States and is the number one killer of
Americans. High blood pressure is the second leading cause of preventable heart
attacks; the key word being preventable (Kolata, 2017). If blood pressure is
managed, it can significantly reduce the chances of having a heart attack.
Taking this into account, new guidelines issued by the American Heart
Association (AHA) will increase the number of Americans diagnosed with high blood
pressure. Until recently, individuals with a blood pressure of 140/90 were
considered to have high blood pressure. However, the AHA now states that
individuals with a blood pressure of 130/80 are considered to have high blood
pressure (American Heart Association News, 2017). This means that three times
more men under the age of 45 will be diagnosed with high blood pressure while
two times more women under the age of 45 will be diagnosed. In total, the number
of Americans diagnosed with high blood pressure will increase from 72 to 103
million people (Kolata, 2017). These are scary numbers to think about so what
does it actually mean for Americans and for doctors?
Basically,
the idea behind lowering the cutoff for high blood pressure diagnosis is so
patients start managing their blood pressure earlier. The AHA clarifies that
patients with a blood pressure at or above a 129 will be considered “elevated”.
Although more patients will be diagnosed high blood pressure, this does not
necessarily mean that more medication will be given immediately. The AHA
emphasizes that more focus needs to be placed on patient’s living healthier
lifestyles. This includes things like eating a healthier diet and increasing
exercise (American Heart Association News, 2017). It may seem like we hear
about diet and exercise as a way to prevent chronic diseases constantly yet
millions of Americans still die from heart disease every year. These guidelines
by the AHA further push the importance of preventing heart disease caused by
high blood pressure. Furthermore, the AHA also wants to ensure that high blood
pressure is measured and diagnosed accurately by healthcare professionals so
preventative measures can be taken much earlier to prevent later risk
associated with high blood pressure (American Heart Association News, 2017). With
these new guidelines in place, it will be interesting to see how the increased
number of diagnoses affects cardiovascular disease statistics in the United
States.
References:
American Heart Association News. (2017,
November 13). Nearly half of U.S. adults could now be classified with high
blood pressure, under new definitions. Retrieved from https://news.heart.org/nearly-half-u-s-adults-now-classified-high-blood-pressure-new-definitions/
Kolata, G. (2017). Under New Guidelines,
Millions More Americans Will Need to Lower Blood Pressure. Retrieved November
13, 2017, from https://www.nytimes.com/2017/11/13/health/blood-pressure-treatment-guidelines.html
This is really interesting. I am curious how it was calculated that the total number of Americans diagnosed with high blood pressure would increase from 72 to 103 million people, as that seems like a very specific estimate. In addition, I find it interesting that the AHA believes that though more patients will be diagnosed with high blood pressure there will not necessarily be an increase in medication being prescribed. I, personally, find this hard to believe. I could see patients who are diagnosed with high blood pressure and do not have a desire to make lifestyle changes demanding medication. I could also imagine it being difficult to get physicians who have been practicing for a long time to adhere to these new standards. For patients who are in good health and do not have lifestyle-associated risk factors for high blood pressure but have a genetic predisposition for it and so are diagnosed with hypertension, will these patients be administered medication? I am curious, do you think it is ethical to diagnose patients with high blood pressure, but not treat them for it knowing the risks associated and the uncertainty of whether or not patients will make appropriate lifestyle changes?
ReplyDeleteGreat post and comment!
ReplyDeleteTaylor brought up some very important questions. One I thought about was what they are hoping to achieve by changing this HTN pressure criteria from 140/90 to 130/80. Could it be that they hope to induce some type of preventative care strategy for patients at risk of developing HTN? I know you answered this in the second paragraph when you stated that the hope is for patients to get a handle on their blood pressure much earlier so that they don’t have to start taking blood pressure lowering medications. That being said; perhaps they also hope that some time after this change has been made, there will be an overall decrease in the amount of new HTN diagnoses and a likewise decrease in prescriptions for HTN medications? This makes the most sense to me but let me know what you think!
Additionally, some patients might get very upset or concerned for their health if they get diagnosed with HTN, is it ethical to prematurely “scare them straight”? Much like adolescents taken to see what their futures will look like if they don’t start behaving (scared straight programs). I believe this will overall do some good and that the benefits will outweigh any negative impacts but only time will tell.
Alicia, I just came across a study that has me questioning this new high blood pressure definition. Is 130/80 really low enough?! According to this 2015 study published in the New England Journal of Medicine, researchers concluded that if adults with hypertension maintained a systolic blood pressure <120 then they had significantly better health outcomes. They were 25% less likely to have an MI or a stroke, 38% less likely to have heart failure, 43% less likely to die from cardiovascular causes and 27% less likely to die prematurely from other causes.
ReplyDeleteIt is important to note that this trial reported higher rates of adverse events within the study group and the fact that maintaining a systolic blood pressure of <120 requires intense monitoring along with lifestyle changes and higher doses of antihypertensive drugs. Regardless, I wonder if, in the race to combat cardiovascular, recommendations for the ideal blood pressure will continue to plummet?
Wright, Jackson T., et al. “A randomized trial of intensive versus standard blood-pressure control.” New England Journal of Medicine 373.22 (2015): 2103-2116.