As of Friday, March 21, 2014
DEAR DOCTOR K: I’m 68 years old and I take blood-pressure lowering medication. What do the new blood pressure guidelines mean for people of my age?
DEAR READER: You’re asking about new guidelines for managing high blood pressure, or hypertension, in adults. They were published recently by an expert panel of specialists in high blood pressure.
You may have noticed that experts (on any subject) don’t always agree with each other. And sometimes they really don’t agree with each other. That’s the case with these guidelines. They are controversial, and I’ll explain why.
But first, some basics. Blood pressure is the force the blood exerts on your arteries when it is pumped out of the heart. Blood pressure is written as two numbers, recorded in millimeters of mercury (mm Hg).
Systolic pressure (the top number of a blood pressure reading) is the pressure during the heart’s pumping phase. Diastolic pressure (the bottom number) is the pressure during the resting phase, between heartbeats. I’ve put an illustration of how blood pressure is measured on my website, AskDoctorK.com.
The current categories of blood pressure are:
— Normal: less than 120/80 mm Hg
— Prehypertension: 120-139/80-89 mm Hg
— Hypertension: greater than 140/90 mm Hg
Why do we worry about high blood pressure? If you have it, and don’t have it treated, high blood pressure increases your risk of heart attack, stroke, kidney failure, aneurysms of the body’s main artery (the aorta) and of arteries in the brain, eye damage, problems with thinking and memory loss.
There’s no doubt that treating high blood pressure above a certain level reduces your risk of all these bad things. Like you, and millions of others, I have high blood pressure. I absolutely want it treated, and I don’t forget to take my pills.
Like the old guidelines, the new guidelines recommend that adults ages 30 to 59 should get treatment if their blood pressure is above 140/90 mm Hg.
However, the new guidelines do give adults ages 60 and older a bit more leeway. Treatment is not automatically recommended in this age group for people with blood pressures of 140-149/90, unless they have diabetes or kidney disease.
Why not? The experts who published the new guidelines argue that in such people the benefits of treatment are not as clearly proven, and side effects from blood pressure medicines are more common. Other experts disagree. While I’m not a blood pressure expert, based on what I know, I treat blood pressure in people 60 and older when it is over 140/90.
The guidelines recommend that everyone with hypertension and prehypertension adopt lifestyle changes known to control blood pressure. These include:
— Losing weight if needed
— Limiting salt intake
— Eating a diet rich in fruits, vegetables, and whole grains
— Staying physically active.
Even though there is some controversy about when to treat high blood pressure in people 60 and older, there’s no controversy about the value of treatment.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.