Lowering the Threshold to Diagnose Hypertension


Did you notice that the American Heart Association in conjunction with the American College of Cardiology issued a new guideline lowering the threshold to diagnose hypertension. These guidelines were released during the American Heart Association Scientific session November 11-12 2017. Depending on who you are these have received great praise or great disdain. Not only did these guidelines lower the threshold for stage one hypertension it also calls persons with a systolic blood pressure reading of 120 mm Hg to 129 mm Hg and a diastolic pressure lower than 80 mm Hg as having elevated blood pressure. If you are unaware, a systolic pressure of 120 and a diastolic pressure of 80 (120/80) has been called normal as far back as I can find in looking into the history of blood pressure measurements.

From what I have been able to read this change is partially due to a need to change the classification system of hypertension. Apparently some people at the top of the healthcare food chain didn’t like the present classification system and wanted to get rid of the per-hypertension diagnosis altogether. This current classification system would call what was normal blood pressure elevated and what was pre-hypertension now stage-1 hypertension. If you were stage 1 you are probably going to be bumped up to stage 2 and so on. The authors say this new classification system will only result in a small increase in the number of patients who can be treated by medication for hypertension. They also say this classification system will allow for the use of stronger medications in other patients. The authors also say this the treatment of stage-1 hypertension will still be focused on lifestyle modification but I have my doubts.

I have read a few articles which are very critical of this new classification system. Many of them point to some sort of collusion between the AHA and pharmaceutical industry and I totally see their point. This change could result in far more people having access to hypertension drugs than the authors think. I don’t like to disparage primary care doctors because they are doing the best they can but I don’t know many primary care doctors who have the time to teach their patients proper lifestyle modifications which result in a substantial change in health. What I see happening more is a PCP gives recommendations, a patient half hardheartedly attempts these changes, the patient fails, returns for a follow-up visit with the PCP who finds dietary changes didn’t work so it’s time for the medications. My scenario is not a failure of the doctor or patient but a failure of the system to provide resources to properly teach a patient and provide support to ensure success.

What I found fascinating is that a day after this AHA joint scientific session a paper was published in the Journal of the American Medical Association which found that the current classification system was ideal. The conclusion of the study titled, Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels – A Systematic Review and Meta-analysis” found that under a systolic blood pressure measurement of 140 mm Hg treatment is not associated with any benefit in primary prevention. This article was published on November 13, 2017 and completely challenges the AHA position. I hate this AHA guideline change so finding legit research that opposes it published the day after the AHA joint scientific sessions concluded was awesome.  The authors of this paper are Swedish and as we all know they do health care and health prevention in Europe much better than we do here.

Under my license I cannot tell a patient what they should or shouldn’t do as far as taking or not taking prescription medications. What I can say is that you, all of us, need to be our own advocates when it comes to the recommendations physicians make. Do your research, read legitimate sources from both sides and come to an educated decision on what to do about your health.

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Posted in Healthcare Policy and Politics, Wellness

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