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New recommendations on Blood Pressure Medication

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Thousands of adults may be needlessly taking tablets for high blood pressure, doctors say.

A panel of experts in the U.S. has recommended that adults over 60 should only be prescribed medicine when their blood pressure levels reach 150 over 90 or higher.

This is due to the side effects that blood pressure tablets can cause, such as fainting and falls in older people and interaction with other medicines they are taking.

The new guidance was published in the Journal of the American Medical Association.

In it, the doctors stress they are not changing the definition of high blood pressure: 140/90.

People with heart disease, diabetes or chronic kidney disease must should aim for a reading of 130/80 or lower.

In the new American guidance, adults aged 60 and older, they are recommending a higher treatment threshold, prescribing medicine only when blood pressure levels reach 150 over 90 or higher.

Too aggressive blood pressure treatment can cause fainting and falls in older patients, or bad interactions with drugs they're already taking for other illnesses, panel members said.


However much of the existing guidance does remain - such as giving younger adults with a reading of 140/90 medication and also those with diabetes or kidney disease.

A third of people in the UK and U.S. have high blood pressure - and a third do not realise. It is a major risk factor for heart disease, stroke, and kidney failure.

Every day there are 350 preventable strokes or heart attacks in the UK due to high blood pressure.

A high blood pressure reading is one that exceeds 140/90 millimetres of mercury (mm Hg).
The first figure, the systolic pressure, corresponds to the ‘surge’ that occurs with each heart beat.

The condition typically has no symptoms, so it goes undetected or untreated in many people.


High blood pressure is a major risk factor for heart disease, stroke, and kidney failure

In developed countries like the UK, the lifetime risk of developing high blood pressure is now 90 per cent and six million Britons take drugs to control it - usually for life.

People with hypertension - the medical term - are routinely advised to change their lifestyle and eat less salt, lose weight, drink less alcohol, eat more fruit and vegetables and exercise more.

The new guidelines were based on a review of the most rigorous kind of medical research - studies in which patients are randomly prescribed drugs or dummy pills - published since the last update in 2003.

The research suggests older patients can avoid major health problems like heart attacks, strokes and kidney disease even when their blood pressure is above the current recommended level, the panel said.

For many patients, two or three drugs - or more - are needed to bring their blood pressure down.

Many older adults could probably reduce their doses, or take fewer drugs, to reach the new, less strict target, said Dr. Paul James, a panel member and family medicine specialist-researcher at the University of Iowa.

While the guidelines were updated by a government-appointed panel, they don't yet have the government's endorsement like previous versions.

And some doctors fear the experts didn't take into account the effects of under treating high blood pressure in older people.
Dr. Curtis Rimmerman, a Cleveland Clinic cardiologist, called the guidelines "exceedingly important" given the prevalence of high blood pressure, which affects about 1 in 3 adults.

The panel added that the guidelines are simply recommendations, and that doctors should make treatment decisions based on patients' individual circumstances.

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