Here's What You Need To Know About The New Blood Pressure Medication Guidelines

If you have high blood pressure, your treatment may soon change.

New medication guidelines published Dec. 18 in the Journal of the American Medical Association (JAMA) suggest that not everyone with high blood pressure needs to be on drugs for it.

Here's the bottom line: If you are 60 or older and the first number of your blood pressure is less than 150, you don't necessarily need to be on medication for it.

Keep in mind that this choice is up to your doctor — blood pressure is just one risk factor for heart disease, and people using medication to maintain a number in the 140s without serious side effects should not suddenly stop and let that number drift up.

The new guideline will decrease the number of people medicated for their high blood pressure, but not everyone's happy about it.
Blood pressure and heart disease

People with naturally low blood pressure (BP) have a lower risk of cardiovascular problems and live longer. High blood pressure, when left uncontrolled, can lead to heart attack, stroke, and aneurysm. Smoking, obesity, and inactivity are all risk factors for high blood pressure, which also has a genetic component that's passed down in families.

Lifestyle changes like exercise and healthy eating are our first line of defense against heart disease and are especially encouraged if BP creeps above the "normal" level of 120/80.
But not everyone gets their blood pressure low enough with just lifestyle changes, and if that first number climbs above 140 — a condition affecting about two-thirds of people 60 and older — you officially have high blood pressure, or hypertension.
Until now, that's when doctors suggest medication to help lower BP. About 50 million Americans are on blood pressure drugs of all different kinds, including diuretics ("water pills"), beta blockers (which slow your heartbeat), and ACE inhibitors (which help stop blood vessels from narrowing).
Why change the guidelines?

"Over the last ten years, doctors have had the notion that the lower blood pressure is, the better," study researcher Paul A. James, of the University of Iowa, told Business Insider.

The problem? While there's no question that medication is crucial for people at high risk of heart attack and stroke, the researchers concluded that there's not enough evidence that driving that number all the way to 140 — rather than simply to 150 — provides much additional benefit.
The panel arrived at the new guidelines after reviewing previous studies that looked at how patients fared on a variety of approaches to lowering BP — different drugs and exercise regimens, for example.
Blood pressure drugs, like any medications, have some side effects (such as dizziness), which can be especially serious in older adults. So, the new guidelines may come as a relief for some.
Still, says James, "I'm absolutely sure there will be controversy."

Not everyone's happy

James is right. Some people are wary that the new guidelines aren't officially endorsed by the National Heart, Lung, and Blood Institute (NHLBI).
The NHLBI initially assembled the panel but has since stopped being involved in making guidelines, so in the end they weren't certified by any official organization. Eric D. Peterson of the Duke Clinical Research Institute told Business Insider that this lack of official endorsement may leave some practicing doctors scratching their heads about how to proceed.
Most experts point out that more research needs to be done. "We have very limited data to tell us what the right thresholds are," said Peterson.
While he agrees that no study says 140 is the magic BP number for beginning treatment in older adults, he notes that one major study showed a notable benefit when older patients brought their number from the mid-150s to the mid-140s — so 150 isn't necessarily right either.
Though Peterson agrees that too-aggressive treatment to lower a patient's blood pressure down to a specific number can harm overall health, he compared the target numbers to speed limits: If you tell people the maximum speed is 65, they may drive at 75. Similarly, leaving the target at 140 may mean more Americans actually bring their number below 150.

"There is always some slippage between targets set for clinicians and [those] actually achieved in routine practice," he writes in an editorial in the same issue of JAMA.