What Are the Current Standards for Blood Pressure and Are They Adequate?

[Monique]

What are the established standards for normal and hypertensive blood pressure values?

According to my doctor diastolic pressures are nowadays ignored, as they are not meaningful (surprisingly). Systolic blood pressure is regarded as an important value, but a female under 40 is allowed to have a systolic pressure of 180. This because the chance of dying from cardiovascular disease in the coming 10 years is only 1%.

It surprises me that the chance of dying of cardiovascular illness in the coming 10 years is used as the standard.

Between the age of 40–60: only a female of 55–60 year old, who is a smoker, has high cholesterol, a systolic blood pressure of >180 and thus a 22% chance of dying the coming 10 years of cardiovascular disease would get medical treatment. Men have a much higher risk.

It would lead me to conclude (based on the http://nhgcorp-web10.prolocation.net/sites/default/files/bsl/images/M84-01.jpg) that a female doesn't need to measure blood pressure, unless she's 65+ years old or has a strong family history.

The guideline seems to ignore the effect of blood pressure on other organs, is it a good one?

 

[Simon Bridge]

This is in the USA?

iirc In the USA there have been recommendations (since last year) to change the way high blood pressure is treated - with higher BP in older adults being treated less aggressively. It is still not "OK" to have high BP. It's just that there have been a bunch of peer-reviewed studies since 2003 (last guidelines) indicating that many patients do not benefit enough from the higher med doses to be worth the risk the drugs pose.

Caveat: what follows is not medical advise.
If you have concerns about the advise you are getting from a doctor, you are urged to seek a second opinion from another doctor who has examined you.

You've probably had a go looking for information online - it's a bit of a maze isn't it?
Off my recollection I had a go looking for decent backup rather than just going off the top of my head... I found:

JAMA Aricle: http://jama.jamanetwork.com/article.aspx?articleid=1791497&resultClick=3
... which looks pretty much like what I remember: Evidence Based Guidelines...
Too technical? Try: http://www.webmd.com/hypertension-h...idelines-raise-the-bar-for-taking-medications

These are only guidelines, not standards, and there is a lot of disagreement on details.

ferinstance AHA and ACC have their own guidelines.
i.e. http://www.heart.org/HEARTORG/Condi...lood-Pressure-Readings_UCM_301764_Article.jsp
I saw that the AAFP has a bunch of guidelines too but they are behind a paywall.

For perspective: http://www.bloodpressureuk.org/BloodPressureandyou/FAQs/Bloodpressurenumbers
(A UK reference - re: emphasis on systolic pressure etc. I'm having trouble finding the equivalent for US.)

It may just be that your doctor is giving you simplified explanations intended to reassure you.

Still, best advise is the same: seek the opinion of another physician who has examined you.

 

[Monique]

This is in the USA?

No, NL, but I'm looking for scientific information or guidelines of developed countries (which I'm sure lags behind scientific studies) so that doesn't depend on location.

Indeed information on the web is a maze and definitely I didn't learn about the guideline that diastolic pressure is not informative. Thanks for the links, I'll check them out.

No worries about second opinion, this is just new information that I'd like to brush up on.

 

[Simon Bridge]

The citations in the JAMA article should give you a starting point for the scientific information these sorts of decisions are based on... but you know to do that :)

NL = Netherlands?
Around 200-2004 there was concern about under-treatment of hypertension in the Netherlands.
i.e. http://www.nature.com/jhh/journal/v18/n5/full/1001672a.html

Have you seen:
http://www.seh-lelha.org/pdf/guia2007seh.pdf[/URL]
2007 Guidelines for the Management of Arterial Hypertension (Netherlands)
I don't know if there was a more recent revision but the 2003 one is still kicking around too.
It's a great cure for insomnia.

The trick seems to look for "guidelines for treatment and diagnosis hypertension Europe" ... scholar, for eg, throws up even a few metastudies.

My connection is via family, poking my nose in where it don't belong, and some related biophysics.. so I've about hit the limit of my usefulness. Hopefully this'll have given you some solid leads short of actually asking a specialist physician.

Enjoy.

 

[Evo]

From what I've read, the diastolic pressure is more important for younger people and systolic more important for older people. However, both should be watched and if either tends to be elevated consistently, it should not be ignored. Not for you, but for others "seek professional medical advice, we cannot diagnose you".

Diastolic pressure is the force of blood in the arteries as the heart relaxes between beats. It's shown as the bottom number in a blood pressure reading.

The diastolic blood pressure has been and remains, especially for younger people, an important hypertension number. The higher the diastolic blood pressure the greater the risk for heart attacks, strokes and kidney failure. As people become older, the diastolic pressure will begin to decrease and the systolic blood pressure begins to rise and becomes more important. A rise in systolic blood pressure will also increase the chance for heart attacks, strokes, and kidney failure. Your physician will use both the systolic and the diastolic blood pressure to determine your blood pressure category and appropriate prevention and treatment activities.

http://www.nhlbi.nih.gov/hbp/hbp/whathbp.htm

For charts on what is considered high blood pressure.

http://www.heart.org/HEARTORG/Condi...lood-Pressure-Readings_UCM_301764_Article.jsp

 

[Evo]

This is in the USA?

iirc In the USA there have been recommendations (since last year) to change the way high blood pressure is treated - with higher BP in older adults being treated less aggressively. It is still not "OK" to have high BP. It's just that there have been a bunch of peer-reviewed studies since 2003 (last guidelines) indicating that many patients do not benefit enough from the higher med doses to be worth the risk the drugs pose.

Simon, where are you reading that they are not recommending medications for BP as much? In the JAMA report every one of their recommendations starts with

Recommendation 1
In the general population aged 60 years or older, initiate pharmacologic treatment to lower BP

Recommendation 2
In the general population younger than 60 years, initiate pharmacologic treatment to lower BP

Recommendation 3
In the general population younger than 60 years, initiate pharmacologic treatment to lower BP

Recommendation 4
In the population aged 18 years or older with CKD, initiate pharmacologic treatment to lower BP

Pharmacological treatment is the first recommendation in every scenario they list.

Are you talking about at the bottom where they agree that lifestyle changes are also important?

It is important to note that this evidence-based guideline has not redefined high BP, and the panel believes that the 140/90 mm Hg definition from JNC 7 remains reasonable. The relationship between naturally occurring BP and risk is linear down to very low BP, but the benefit of treating to these lower levels with antihypertensive drugs is not established. For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs. Although the authors of this hypertension guideline did not conduct an evidence review of lifestyle treatments in patients taking and not taking antihypertensive medication, we support the recommendations of the 2013 Lifestyle Work Group.45

Bolding mine.

This is saying that with healthy changes, it may be possible to reduce medication needs, not that medications shouldn't be the first line of treatment until it is seen if lifestyle changes make a difference.

 

[Simon Bridge]

Thank you Evo; I'm glad you asked...
Short answer: not in so many words they don't.
Look at target BP's in each group, the threshold for treatment, and compare with the 2003 guidelines.

... it certainly means starting particular groups on meds later.
That may mean something for the doses or I may have worded that a tad strongly.

People living in the USA can be expected to interpret the conclusions better ;)

 

[Evo]

Thank you Evo; I'm glad you asked...
Short answer: not in so many words they don't.
Look at target BP's in each group, the threshold for treatment, and compare with the 2003 guidelines.

... it certainly means starting particular groups on meds later.
That may mean something for the doses or I may have worded that a tad strongly.

People living in the USA can be expected to interpret the conclusions better ;)

Well, the proper lifestyle changes implemented early enough could prevent or delay high BP. Everyone in my family had high BP at an early age, my father was diagnosed at age 14. I actually had low BP until my late 40's when it skyrocketed, but I was always thin, worked out a lot and ate a naturally heart healhy diet, so it delayed things. But my dad was thin all of his life and was on BP meds, maybe why he managed to live until he was 53.

 

[Simon Bridge]

Sure - there are conflicting reports about how lifestyle could affect those already with hypertension but the contributing factors are well established. I put my low BP down to not having kids.

But I mean the changed thresholds start some groups on meds later.