New guidelines out for treating hypertension

Posted Dec 22, 2013 by Karen Graham
Blood pressure can be difficult to understand because it means more than just a set of numbers. We have been told for years that a measurement of 120/80 is the ideal that is considered normal. But now, there are new guidelines for clinicians to follow.
Medical students taking blood pressure readings.
Medical students taking blood pressure readings.
To understand the new guidelines, it's important to know what blood pressure is, and why it is important. Blood pressure is the measurement of the blood flowing through our arteries. When arteries are supple and flexible, the blood carrying oxygen to our vital organs, the heart, lungs, kidneys and other parts of our body, moves freely, and normal metabolism is maintained.
Blood pressure measurement is actually measured within the arteries at two different times. The first reading, the systolic reading, measures the pressure when blood is being pumped by the heart through the arteries to the body. The second reading, called the diastolic reading, measures the pressure inside the arteries when the heart is receiving blood returning back from the body.
Chart showing blood pressure and blood flow
Chart showing blood pressure and blood flow
In the healthy individual, pressure within the arteries is always present and is maintained whether the heart is pumping, or at rest between beats. Without a constant pressure keeping the walls of the arteries supported, they would collapse. This is the reason for taking a blood pressure reading, sometimes over a period of time. This way, a doctor can determine what is considered "normal," or what need to be further investigated.
New Guidelines for Hypertension control
High blood pressure, or hypertension, has for many years been a blood pressure reading of over 120/80. Numerous readings higher than the baseline 120/80 usually meant a course of exercise and diet control first, and if that didn't bring the reading down, a course of medication.
On Dec. 18, 2013, a new set of guidelines was released by members of the Eighth Joint National Committee, and published online in JAMA. The guidelines addressed the management of hypertension as well as a flow chart and recommendations for treatment of patients with hypertension, the most common primary care condition seen in the doctor's office.
Three questions were asked by the committee. They were as follows:
1. In a patient with hypertension, at what blood pressure reading should medication be
2. What blood pressure reading should a patient look for to know they are receiving the right
benefits from there medication?
3. When starting treatment for hypertension, what are the best medicine choices to use?
Committee recommendations
Rather than set an arbitrary reading as being when to start medications, the committee instead identified "threshold blood pressure levels" to use in starting treatment. They also were adamant in emphasizing the importance of a healthy diet and exercise, which could lead to reducing medications.
As for all patients having a "goal" blood pressure reading to strive for, it was noted that each case may be different, depending on age, overall health outlook and other risk factors. Again, there were guidelines for a clinician to follow.
The American Heart Association and the AMA are both recommending that "statins" be used more regularly as a means of reducing cholesterol, and helping to reduce blood pressure as well. The AHA and AMA are looking at obesity as a medical disease, and this, along with high cholesterol and high blood pressure can be treated more successfully with the new plan.
In concluding their guidelines, the committee also was quick to point out the importance of the doctor:
"However, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient."
Table showing the new recommended hypertension reading levels
Table showing the new recommended hypertension reading levels
American Heart Association and AMA
It must be repeated, and that is to always follow your family doctor's advice when being treated for hypertension.