New Blood Pressure Guidelines

In December 2013 an expert panel on hypertension published its latest recommendations in the Journal of the American Medical Association. In essence these are the recommendations:  1. The target BP for patients over 60 is now 150/90. It used to be 140/90.  2. There is insufficient evidence to support a target systolic blood pressure for people under the age of 60.  3. Reduction of one risk factor (in this case hypertension)  for heart attacks, strokes and premature death by using a drug does not in and of itself mean that patients are less likely to suffer these events. These recommendations make sense to me because as we age, the compliance of our blood vessels decreases, they become less flexible and our blood pressure rises over time. To try and maintain an otherwise healthy patient over 60 to a BP of 120/80 never made much sense to me. These recommendations bring up other issues such as the side effects that patients must suffer in order to achieve an inappropriate target. Also, there is the fact that some blood pressure medications raise the risk of diabetes and elevated cholesterol, for which more drugs are then prescribed. These recommendations are stunning in that it is a tacit admission that research for discovering a target blood pressure for patients under 60 has been inadequate yet doctors constantly prescribe medication to a target of 120/80. This is an example of a frequent logical flaw perpetrated by a profession that tries to project an image of being scientific. It may be common sense to think that if a certain target BP is good for patients over 60, then a lower target must be good for patients under sixty. Well, that's not very scientific and my point is that if conventional docs are going to wear white lab coats, then maybe they should base their recommendations on science or at least admit that they don't have the data. This logical bait-and-switch is not uncommon in medicine which is fraught with tradition, customs and "common sense" thinking. Consider the radical mastectomy. Take out as much tissue as possible - makes sense right? How many women were disfigured by an operation that was routinely performed for breast cancer before research showed that a lumpectomy, in many cases, was all that was ever needed?  I could go on and on with routine tonsillectomies, myringotmy tubes for allergic kids with ear infections, knee surgeries for pain, routine chest x-rays, etc, etc.

Blood pressure, per se, is just a measurement and not a disease. Essential hypertension generally does not produce symptoms that can be used to prescribe a homeopathic remedy. In my practice, if elevated BP is symptomatic, then a remedy for hypertension can be found. If not, then life style/diet modification and constitutional prescribing are used to lower an age- inappropriate blood pressure. Osteopathic manipulation of the cranial, cervical and thoracic areas, including the diaphragm often leads to improvement of blood pressure. Breathing exercise and meditation are also helpful adjuncts in the treatment of hypertension. Some patients may need to be maintained on a low dose anti-hypertensive if all other measures fail to bring the pressure down.

 

UPDATE: Well, it didn't take long for the insights of the above mentioned study to be challenged. The October 1, 2015 issue of Family Practice News, reported the results of an NIH sponsored study called SPRINT that showed if physicians treated hypertension to a systolic target of 120 rather than 140, deaths were reduced by 25%. This reduction in mortality was so dramatic, the study was ended early.  The SPRINT study involved more than 9300 people from the US and Puerto Rico who were at least 50 years old. The subjects received any combination of medications needed to get the systolic pressure down to 120. Sometimes 3 medications were used.  The complete results are still being analysed and no specific guidance for the medical profession has been provided. When the full results are in, we should be able to tell how well the more aggressive approach is tolerated by patients. The study was funded by the NIH and 2 drug companies, Takeda and Arbor that both make and provided some of the medications used in the study. When the full results are released in 2016, I will update this entry again. Stay tuned.