Doctors have been waiting a long time to read what the Eighth Joint National Commission on Hypertension (JNC8) would recommend for current treatment of patients with high blood pressure. They were finally published yesterday in the Journal of the American Medical Association online
These recommendations were based on only the most rigorous of scientific data, randomized controlled trials and so can be considered evidence-based.
The most important change in them compared to previous recommendations and current clinical practice is more lenient blood pressure goals.
There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion.
This is a big change for the blood pressure target in older patients and a welcome one. As a cardiologist I see a lot of older patients who pass out, fall, become dizzy on standing or are imbalanced on walking. Sometimes passing out (syncope) is due to abnormal heart rhythms or major structural problems with the heart. But in many instances, the fall, dizziness, imbalance, instability is related to inadequate perfusion of the brain due to lower blood pressures on standing. I can often alleviate or prevent completely these problems by downward adjustment or elimination of some of the patient’s blood pressure medications.
With these less stringent BP goals, I think we will help to improve older individuals quality of life.
Higher BP goals will mean less BP medications and lower dosages and less interactions with other medications.