Expert: New blood pressure guidelines unrealistic
The American Heart Association's new guidelines for high blood pressure are unrealistic, according to a local hypertension expert who suspects many other doctors share his opinion.
“I think it is quite impractical and might go so far to say impossible for physicians and patients to fully absorb and adhere to these guidelines,” Dr. Matthew Muldoon, director of the UPMC Heart and Vascular Institute Hypertension Center, told the Tribune-Review Tuesday. “I'm sure a lot of primary care doctors are saying, ‘Oh my gosh, are you kidding me?' I'm still in a little bit of shock myself.”
The new classification for high blood pressure — a top reading of 130 (systolic) and a bottom reading of 80 (diastolic) — replaces the former threshold of at least 140 over 90.
The change means an additional 14 percent of U.S. adults have high blood pressure, or 46 percent total versus 32 percent under the old levels.
“The folks who wrote the guidelines said it's worth it, but I'm challenged to understand whether they really wrapped their heads around the implications,” Muldoon said. “The existing guidelines were challenging enough for doctors and patients to try and adhere to.”
For example, a person who lost 15 pounds, exercised a few days a week and took medication in order to lower his or her blood pressure will now have to do more, or even take more medication.
“Any time guidelines like this change, it's a boom for drug companies,” Muldoon said. “The market just increased tremendously.”
Besides medication, which is fairly cheap and available in generic form, the recommended ways to lower blood pressure include losing weight, exercise, lowering sodium intake and reducing alcohol consumption.
Dr. Srinivas Murali, medical director of Allegheny Health Networks's Cardiovascular Institute, said the new guidelines should serve as a wake-up call to doctors and patients alike.
“I know it is going to be hard — no question about it,” he said of meeting the new threshold. “But I don't think as a medical community we have been aggressive enough in managing high blood pressure.”
After cigarette smoking, high blood pressure is the most significant risk factor for stroke and cardiovascular disease, Murali said.
“Being more aggressive in dealing with hypertension doesn't have to mean everybody is going to take two or three more medications,” he said. “Patients need to manage things like weight loss and salt intake. That's where the emphasis needs to be and it's an important lesson for all of us.”
Many doctors cite the so-called “DASH” diet as the most effective intervention in lowering blood pressure. The diet calls for eating fruits, vegetables and whole grains, and discourages foods high in saturated and total fats. DASH stands for Dietary Approaches to Stop Hypertension.
“There's a real problem with the western lifestyle,” said Dr. Thomas Pangburn, chief innovation officer for MedExpress, a network of walk-in clinics in Pennsylvania and other states. “The over-consumption of fast food, processed foods, simple sugars is a serious problem. This data and these guidelines reinforce that we need to take a lot of our lifestyle seriously and look at what modifications we can make.”
UPMC's Muldoon fully understands the importance of maintaining healthy blood pressures. Still, he expects a lot of tough conversations in doctors' offices in the next few weeks or months.
“We work so hard to get people below 140/90. Now we've got to say, ‘Hey, guess what? What was good enough is no longer enough?'” he said. “That's a hard message. Ten points is a lot. That may not sound like much but it is.”