Central PA Medicine Spring 2018 - 25

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Hypertension is a major risk factor in
cardiovascular disease and death.  It is
the #1 modifiable cause of cardiovascular
death, and trails only smoking as the
leading modifiable risk factor for all-cause
mortality.  As such, efforts to prevent and
treat this condition can yield improvements in life span and in quality of life,
as well as lower (yet, in other respects,
higher) health care costs.
 This past year, 43 experts in hypertension, on behalf of the American College
of Cardiology and the American Heart
Association, joined in a task force to update recommendations about the diagnosis
and treatment of hypertension. The big
news is that they decreased the goal of
treatment from 140/90 to 130/80.  This
means that an extra 31 million people
now meet criteria for having high blood
pressure, and the proportion of adults with
this condition rises from 32% to 46%. 
That's why this is such a big deal, because
it means that nearly half of all adults
are now being labelled with a "disease." 
Including those who have already been
labelled as being hypertensive before November, 53% will now need better control. 
The use of medication will be guided not
only by personal trends of blood pressure
readings, but by the co-existent presence
of cerebrovascular disease ("CVD," which
includes coronary artery disease, stroke,
and heart failure), diabetes mellitus, or by
a greater than 10% 10-year risk of CVD,
as measured by standardized scales.  The
new recommendations call for greater
emphasis on lifestyle changes than before. 
In a nutshell, adults under age 65 and
at low risk of CVD should try lifestyle
changes initially, whereas those over 65, or
those of any age with higher risk factors
(such as smoking, obesity, or family history
of early heart disease) should consider
medication more aggressively.  

the new
guidelines
also call
for greater
emphasis
on home
blood
pressure
monitoring.
used an average of 2.8 medications,
compared to 1.8 medications in the
group who tried to reach a target pressure
of 140/90.  The patients who reached
blood pressure levels of 130/80 showed
significant reductions in heart attacks,
strokes and heart failure.

 The new guidelines also call for greater
emphasis on home blood pressure monitoring. This can be achieved with easy-to-use
devices available at nearly any drugstore. 
Patterns of readings should play a role in
decision making, rather than taking action
 A major influence in the change was on single,  mildly elevated numbers.  If
the SPRINT trial, published in the New one out of ten of your readings is 142/92,
England Journal of Medicine in 2015.  and the other nine are under 130/80, then
Two groups of hypertensive patients were medications are not necessary.
tasked to achieve both the older and the
newer target levels. The intensive group
 

These changes of treatment goals are
likely to lead to longer lifespan averages,
with overall healthier patients.  As such,
they might also lead to cost savings in
our already bloated national health care
budget.  However, a downside will be
higher costs in other sectors, as doctors
will now have to deal with 31 million
more patients with a defined disorder. 
This will include a much higher use of
drugs to lower blood pressure, as well as
the increase in adverse effects that will
follow from such intervention on a large
scale.  The panel was optimistic, however,
that overall health care costs will drop
when balancing these factors.
  As noted above, the new recommendations place very strong emphasis on
lifestyle changes to lower blood pressure,
with medication being used as a second
option.  This will be especially apropos in
younger adults, and anyone who is not yet
on medication to begin with.  We all tend
to think of ourselves as being as patriotic as
Paul Revere, but let's face it...compared to
other countries, lots of Americans are not
in great physical shape in many respects.  It
will take some major efforts to change old
habits in a lot of people.  The American
Heart Association has recently set up
an initiative called "Life's Simple 7," to
promote self-improvement without drugs
in various high-risk qualities of patients. 
Specifically, they include high cholesterol
levels, hypertension, blood sugar, smoking,
body mass index/obesity, physical activity,
and healthy dietary habits.
 Not sure how to change any of these
qualities on your own?  That's what we're
here for...

Central PA Medicine Spring 2018 25
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Table of Contents for the Digital Edition of Central PA Medicine Spring 2018
