Do you have high blood pressure? Depends on which doctor you ask

An estimated 103 million Americans have high blood pressure, and should change their lifestyle or take medication to maintain cardiovascular and heart health.

That number – nearly a third of the country – is based on clinical guidelines adopted in 2017 by the American College of Cardiology, the American Heart Association and other groups.

About 46 percent of adults have hypertension under the guidelines, which are more aggressive than those that came before. They set the threshold for stage one high blood pressure at 130/80, down from the previous benchmark of 140/90.

But primary-care doctor groups are critical of those standards, which they say could leave to over-diagnosis and over-medication – potential problems themselves when patients don’t need them.

The American College of Physicians and the American Academy of Family Physicians recommend medication for adults aged 60 or older with blood pressure above 150. People with a history of stroke or heart trouble should take medication to keep their blood pressure below 140.

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The differing guidelines could confuse patients about the most commonly diagnosed condition during outpatient medical visits.

High blood pressure can contribute to heart failure, heart attack, stroke, and chronic kidney disease. It caused or contributed to 360,000 deaths in 2013, according to the U.S. Department of Health and Human Services.

Paul Muntner, an associate dean at the University of Alabama Birmingham School of Public Health, was part of a research team that estimated the number of Americans with high blood pressure based on the American College of Cardiology and American Heart Association guidelines.

“A lot of Americans have blood pressure levels that are unhealthy and associated with increased risk for cardiovascular disease,” he said.

Muntner said it’s too early to tell whether the 2017 guidelines have made a meaningful difference for patients in curbing stroke or heart attack, or whether patients are more likely to be prescribed blood-pressure drugs or non-drug therapies.

He estimates that 82 million Americans should be on blood pressure-lowering medication, an increase of about 4 million from the previous guidelines.

There are several types of commonly prescribed blood pressure-lowering drugs, including diuretics, calcium-channel blockers, angiotensin converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers such as valsartan and losartan.

Since July, drug companies have recalled dozens of lots of valsartan, losartan and irbesartan –either alone or in combination with other drugs– after testing revealed trace amounts of carcinogens.

Several versions of these drugs were not affected by the recall. Patients can check with their doctor, pharmacist or the Food and Drug Administration’s recall list to see whether their medication is part of the recall.

Most Americans with slightly elevated stage one hypertension should be able to lower their blood pressure by losing weight, exercising and eating less salt and more fruits, vegetables and whole grains.

The primary-care doctors who researched and developed the less-aggressive target of treating older adults with blood pressure above 150 said they attempted to balance the benefits of treating high blood pressure with potential harms.

“That is where you get the biggest bang for the buck,” said Devan Kansagara,associate professor of medicine at Oregon Health and Sciences University and vice chair of the ACP/AAFP clinical guidelines committee.

Kansagara said the primary-care doctors’ guidelines are aimed at preventing heart attack, stroke, even death, while also minimizing side effects of treatment.

“If you ask any patient who has been treated aggressively for blood pressure – we see this in practice all of the time – there are lots of complaints of lightheadedness, feeling unwell and feeling they are about to pass out,” Kansagara said.

Kansagara said more aggressive guidelines can add to the burden of filling more prescriptions and managing multiple medications for marginal benefit.

He said doctors and patients ultimately must discuss the benefits and risks of starting medication based on their overall health.

Ken Alltucker, USA TODAY

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