New JNC 8 guidelines tell doctors to wait with the meds for older hypertension patients.
The 2014 guidelines for the management of hypertension in adults are out and causing quite a stir in the medical industry as it suggests changing treatment goals that have been in place for over 30 years. Issued by a committee of 17 physicians (JNC 8) commissioned by the U.S. National Heart, Lung and Blood Institute, the guidelines prescribe that people aged 60 and over with blood pressure lower than 150/90 may not need to take medication. Previously, 140/90 was considered too high.
The group, who reviewed clinical research on the health effects of lowering blood pressure of 150/90 to 140/90 over a five year period, found no greater likelihood of heart attacks or strokes if the blood pressure remained at 150/90. They therefore strongly recommend that doctors prescribe blood pressure medication only if it measures 150/90 or higher. Their advice means that that millions of American seniors may be on unnecessary antihypertensive medication. The researchers express concern that the side effects of blood pressure medications could be putting some seniors at unnecessary risk.
The researchers however, were careful to add in their concluding remarks, that while their recommendations are based on evidence, “they are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.”
Another strong JNC 8 recommendation is to treat 30 to 59-year old hypertensive patients to a diastolic blood pressure goal of less than 90 mm Hg.
While JNC 7 recommended thiazide-type diuretics for initial therapy in the general population, JNC 8 makes a moderate recommendation for selection of initial treatment from a broader range of medications. A thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker is reported as an acceptable choice for the general non-black population, including those with diabetes.
JNC 8 also makes a moderate recommendation to utilize an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for blood pressure treatment in all chronic kidney disease patients, regardless of race or diabetes status.
The researchers concluded that for all persons with hypertension, “the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”
Besides lifestyle changes, there are other natural treatments for hypertension that avoid the long-term side effects or prescription medications. RESPeRATE, for example, is the first natural, non-drug, medical device clinically proven to lower blood pressure.