Updated 17 April 2015

Heart groups issue updated blood pressure guidelines

More flexibility is the aim for patients with hypertension and heart disease, although there is an ongoing debate as to what blood pressure goals should really be.


Three leading groups of heart experts have issued updated guidelines that set blood pressure goals for people with heart disease.

Lower than 140/90 mm Hg

Specifically, the guidelines reinforce a target blood pressure of less than 140/90 mm Hg for those at risk for heart attack and stroke. The guidelines also set a goal of 130/80 mm Hg for those with heart disease who have already had a heart attack, stroke or a mini-stroke, or who have had a narrowing of their leg arteries or an abdominal aortic aneurysm.

However, the new guidelines are intended to be more flexible than ones crafted in 2007, said Dr Clive Rosendorff, chairman of the committee that wrote the updated guidelines. Ultimately, the blood pressure goal any individual patient tries to achieve should be left to the discretion of the doctor and the patient.

For example, the lower goal may not be appropriate for older, frail patients who might experience dizziness if their blood pressure drops too much.

"Guidelines are simply that, guidelines, they are not inflexible rules," Rosendorff said.

Read: When is blood pressure considered high?

The updated guidelines, from the American Heart Association, the American College of Cardiology and the American Society of Hypertension, were published recently in the journal Hypertension.

"In patients with heart disease, untreated high blood pressure is a major risk for heart attack and stroke," said Rosendorff, who is also a professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Centre in New York City.

Rosendorff said these guidelines are for patients with heart disease. New blood pressure guidelines for people who have high blood pressure but do not have heart disease are in the works, but those won't be released for some time, he said.

Death rate increased 23 percent

High blood pressure has become a growing problem in the United States during the past decade, according to a recent report from the U.S. Centres for Disease Control and Prevention. The overall death rate from high blood pressure has increased 23 percent since 2000, even as the death rate from all other causes has dropped 21 percent. That spike was seen in both genders and was most marked among those aged 45 to 64 and those over 85.

According to Rosendorff, one change in the updated guidelines is a concise statement about which drugs should be used to lower blood pressure in patients with heart disease.

"There are three drugs which have been shown to improve outcomes," he said. These include beta-blockers that slow the heart rate and reduce the force of cardiac contraction and also increase blood flow to the heart, Rosendorff said.

The guidelines also recommend angiotensin II receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACE inhibitors), which increase the size of blood vessels, thus lowering blood pressure, and diuretics that lower blood pressure by reducing the amount of fluid in the body.

Read: 13 high blood pressure facts

Dr Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said men and women with high blood pressure and heart disease may benefit from more cohesive management strategies that target both conditions.

"As large numbers of men and women have not achieved optimal control of their blood pressure and are having major cardiovascular events which could have been prevented, more needs to be done to ensure implementation of these recommendations into routine clinical practice," Fonarow said.

Ongoing debate

Dr Harlan Krumholz, a professor of cardiology at the Yale School of Medicine, views the updated guidelines as part of an ongoing debate among experts as to what blood pressure goals should be.

"The main issue is that not many contemporary trials have focused on patients with high blood pressure in this range, and there is some uncertainty about who benefits most from drug treatment, whether adding additional pills is helpful, and in what sequence. As always, the best path for people with minor elevations of blood pressure is to treat it with lifestyle change, including diet and exercise," he said.

Read More:

Black people more prone to hypertension

Treat hypertension to prevent stroke

Folic acid may ward off stroke in high blood pressure patients

Image: Concept of hypertension from Shutterstock

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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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