New blood pressure guidelines won’t change advice for most patients

Published on November 29, 2017

A UofL Physician says new blood pressure guidelines issued by the American Heart Association this month won’t change medical advice for most patients, but may impact  those who are most at risk for a heart attack. 

Andrew DeFilippis, M.D., a cardiologist with UofL Physicians and director of cardiovascular disease prevention at the UofL School of Medicine, said the new guidelines are based on an ongoing shift in how to treat cardiovascular disease.

“The idea is to use medications for those at greatest risk of having an event - not to just lower blood pressure, but to prevent heart attack or stroke,” he said. “The risk increases above 120/80, but at what threshold is the risk considered high enough when it comes to the risk of the blood pressure medications themselves, or the cost to patients?”

He said the idea is to not to treat everyone the same based solely on their blood pressure. “The greatest benefit is by treating those most at risk, rather than everyone,” he said. 

Doctors use a clinical calculation to estimate a patient’s risk of cardiovascular disease, and DeFilippis has published research on these calculations. He said for those who have risk factors in addition to high blood pressure - such a prior stroke, diabetes or chronic kidney disease - doctors will recommend starting medication to control blood pressure earlier.

The AHA changed the definition of hypertension this month for the first time in 14 years, moving it from 140/90 to 130/80. The guidelines were released at the annual meeting of the American Heart Association. Blood pressure is still considered normal if it is less than 120/80. 

“This is new. In the past, medication was not recommended if a person’s blood pressure was under 140,” he said. 

But for most patients, it won’t change what doctors recommend, though they may be monitored more closely.

“For someone who is otherwise completely healthy, with no risk factors, the recommendations are still the same – to concentrate on lifestyle factors such as diet and exercise and limiting alcohol usage, and follow up with a doctor in 3-6 months,” he said.