Members of Blood Pressure Panel at Odds Over Recently Released Guidelines

Why they voted against raising systolic blood pressure targets for patients over 60

Released: 13-Jan-2014 5:00 PM EST
Source Newsroom: University Hospitals Case Medical Center
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Newswise — Some panel members are speaking out against the decision to raise the threshold at which older adults begin taking medication to control their blood pressure. In a commentary published in the Jan. 14 issue of the Annals of Internal Medicine, some members of the Eighth Joint National Committee, or JNC 8, explain why they voted against relaxing systolic blood pressure targets to 150 mmHg for patients aged 60 and older without diabetes or chronic kidney disease (CKD).

Lead author Jackson Wright, Jr., MD, PhD, Director of the Clinical Hypertension Program at University Hospitals Case Medical Center and Professor of Medicine at Case Western Reserve University School of Medicine, said there was consensus on all of the guidelines issued by the JNC8 except for this one particular guideline about systolic blood pressure.

“We believed that evidence was insufficient to increase the systolic blood pressure goal from its current level of less than 140 mm Hg because of concern that increasing the goal may cause harm by increasing the risk for cardiovascular disease (CVD) and partially undoing the remarkable progress in reducing cardiovascular mortality in Americans older than 60 years,” said Dr. Wright.

“The major concern is that by recommending higher blood pressure targets, for both the initiation of treatment and the treatment targets, we would, in fact, be putting these high risk patients at greater risk for complications of hypertension,” he said.

He said that people over the age of 60 are 50 times more likely to die from strokes and 35 times more likely to die from heart attacks and coronary artery disease than people under the age of 60.

Dr. Wright explained that the original paper was not the place, nor did it have the room, for the explanation, thus the need for the Annals commentary.

“We are simply providing the evidence related to that disagreement. Others will have to judge whether or not they will abide by the recommendation of 140 mm Hg or abide by the recommendation of the majority of the guideline panel, which is a systolic blood pressure target of 150,” said Dr. Wright.

The full commentary is available at this link: http://www.annals.org/article.aspx?doi=10.7326/M13-2981.

An interview with Dr. Wright and b-roll video for multi-media journalists are available on the UH Newsroom at http://news.uhhospitals.org. Register to download content.

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University Hospitals, the second largest employer in Northeast Ohio, serves the needs of patients through an integrated network of hospitals, outpatient centers and primary care physicians in 16 counties. At the core of our health system is University Hospitals Case Medical Center, one of only 18 hospitals in the country to have been named to U.S. News & World Report’s most exclusive rankings list: the Best Hospitals 2013-14 Honor Roll. The primary affiliate of Case Western Reserve University School of Medicine, UH Case Medical Center is home to some of the most prestigious clinical and research centers of excellence in the nation and the world, including cancer, pediatrics, women's health, orthopaedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center at Case Western Reserve University. UH Case Medical Center is the 2012 recipient of the American Hospital Association – McKesson Quest for Quality Prize for its leadership and innovation in quality improvement and safety. For more information, go to www.uhhospitals.org


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