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Higher Blood Pressure Threshold OK in Older Adults, Panel Says

Agency disavows report (December 18)

Many older adults with hypertension can be treated less aggressively, which could mean taking fewer pills to get the disorder under control, according to new treatment guidelines released by panel members appointed to the Eighth Joint National Committee (JNC). But not all experts are on board with the advice — including the government agency that appointed the group, the National Heart, Lung, and Blood Institute (NHLBI).

The panel members emphasized that they are not changing the definition of hypertension: 140/90 mm Hg. For adults aged 60 years and older, however, they are recommending a higher treatment threshold, prescribing medications only when blood pressure levels reach 150/90 mm Hg or higher.

The panel endorses the lower target of 140/90 mm Hg for younger adults — and for all adults who also have diabetes or kidney disease.

The research suggests that older patients can avoid major health problems, such as heart attacks, strokes, and kidney disease, even when their blood pressure is above the current recommended level, the panel said.

While the new guidelines were updated by a government-appointed panel, they don’t have the government’s endorsement, unlike previous versions. In addition, the American Heart Association (AHA) is raising concerns about the new recommendations, saying that many studies on which they are based didn’t last long enough to reveal the dangers of undertreated hypertension in older patients. The panel also overlooked other evidence suggesting that 2003 government-backed recommendations are sound, said Dr. Elliott Antman, the AHA’s president-elect.

Dr. Gary Gibbons, director of the NHLBI, issued a statement emphasizing that his agency has not sanctioned the panel’s report, nor has the broader National Institutes of Health.

According to panel member Dr. Paul James, the panel chose to release its guidelines independently to get the recommendations out sooner and into the hands of primary care physicians, who treat large numbers of patients with hypertension. The guidelines were published online Dec. 18 in JAMA.

Sources: Medical Xpress; December 18, 2013; and JAMA; December 18, 2013.

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