January 19, 2014

Blood Pressure Now Has New Guidelines

With the new guidelines for blood pressure (BP), I may need to talk to my doctor. My BP has been staying about 120 (systolic) over 60 (diastolic) for the last year. I don't feel dizzy when I stand up or when I get out of bed, so I don't feel any urgency to consider a change in BP medications. However, the new guidelines are much higher than my current medications are allowing me.

There are many articles and blogs now being published on the new guidelines. The first I will use is a blog by Joslin Communications and the second is a blog by Dr. Kernisan. The Joslin blog is for people with diabetes and Dr. Kernisan is about for caregivers of the elderly. I urge you to read both blogs.

Joslin Communications
The new 2014 guidelines by the National Institute of Health (Eighth Joint National Committee (JNC 8)) offer a series of changes from JNC7, which was last issued in 2003. “For those with diabetes who are older than 18 years of age, the JNC8 guidelines are in agreement with those recently issued by the American Diabetes Association. JNC8 recommends aiming for a goal blood pressure of 140mmHg systolic and 90mmHg diastolic and to use pharmacological agents if the blood pressure equals or exceeds this level.”

JNC8 based its guidelines on evidence on clinical studies that showed lower BP levels in older adults did not provide any clinical benefit. “The American Heart Association is concerned that liberalizing the goal for those older than 60 could lead to more heart disease as the consequences of high blood pressure develop over years and the studies cited by the JNC8 were not long enough to detect the damage caused by higher blood pressure levels.” At least I can agree with the AHA on this.

Blog by Dr. Leslie Kernisan – for caregivers
I must note that while I don't completely agree (See AHA statement above) she does have some good points to consider. She says, “Experts made the noteworthy decision to modify the blood pressure (BP) treatment target for adults aged 60 or older to less than 150/90—a change from the previous goal of less than 140/90 for the elderly demographic, set forth in the 2003 BP guidelines. In addition, people with diabetes or kidney disease are now advised to aim for a BP of less than 140/90, as opposed to the previous recommendation of less than 130/80.”

Dr. Kernisan advises caregivers to check their loved one's BP with a high-quality BP machine at home. She says to check their BP at the same time of day for 3 to 7 days in a row. She does recommend checking twice a day if possible. She lists a few things to keep in mind and I will quote them.

  • BP is constantly changing within the body, so a series of measurements will give you a more accurate idea of where your loved one's BP usually falls.
  • Home-based BP checks have been shown to correlate better with a person's true BP than occasional office-based BP checks.
  • If your loved one has recently had a fall, or if their systolic BP is less than 120, consider checking their BP both sitting and standing. If BP is dropping a lot when they stand, you'll want to ask their doctor to address this.”

She also knows patients and advises caregivers to check the actual pill bottles on a regular basis. She also cautions caregivers not to rely on a medication list provided by the doctor's office. Some doctors will keep increasing the dosage of BP medication when the real problem is that the patient hasn't been taking the pills.

If you are a caregiver, please read to the bottom of her blog as she has a free Q & A call on this topic and registration is required. She provides the link for this.

2 comments:

Leslie Kernisan, MD MPH said...

Just came across your post as I was Googling for one of my own posts on high blood pressure management.

Thank you for mentioning my blog! I think we can agree that it's good for patients and caregivers to have more information, so they can be better informed about their healthcare choices.

Good luck finding the best approach for your own BP and diabetes.

Bob Fenton said...

Thank you Dr. Kernisan.

This is why I read a lot. My doctors just can't find the time to discuss changing guidelines and to even tell me why they won't change medications.

I receive more information from my pharmacist than my doctors.