[Diabetes-talk] FW: [acb-diabetics] New BP guidelines

[d m gina]

Ug that sure would save on the cost of some of that medicine. Good heavens.

Original message:
> From: acb-diabetics-bounces at acb.org 
> [mailto:acb-diabetics-bounces at acb.org] On Behalf Of Nancy Matulis
> Sent: Wednesday, December 18, 2013 3:41 PM
> To: acb-diabetics at acb.org
> Subject: [acb-diabetics] New BP guidelines




> New Blood Pressure Guidelines Raise the Bar for Taking Medications


> Published: December 18, 2013 12:41 PM
> By Dennis Thompson  HealthDay Reporter


> Photos


>  
> <http://cdn.newsday.com/polopoly_fs/1.6634600.1387388472!/httpImage/image.jpg_gen/derivatives/display_600/image.jpg>

> Fewer people should take medicine to control their high blood pressure, 
> a new set of guidelines recommends.

> Adults aged 60 or older should only take blood pressure medication if 
> their blood pressure exceeds 150/90, which sets a higher bar for 
> treatment than the current guideline of 140/90, according to the 
> report, published online Dec. 18 in the Journal of the American Medical 
> Association.

> The expert panel that crafted the guidelines also recommends that 
> diabetes and kidney patients younger than 60 be treated at the same 
> point as everyone else that age, when their blood pressure exceeds 
> 140/90. Until now, people with those chronic conditions have been 
> prescribed medication when their blood pressure reading topped 130/80.

>   _____





>   _____

> Blood pressure is the force exerted on the inner walls of blood vessels 
> as the heart pumps blood to all parts of the body. The upper reading, 
> known as the systolic pressure, measures that force as the heart 
> contracts and pushes blood out of its chambers. The lower reading, 
> known as diastolic pressure, measures that force as the heart relaxes 
> between contractions. Adult blood pressure is considered normal at 120/80.

> The recommendations are based on clinical evidence showing that 
> stricter guidelines provided no additional benefit to patients, 
> explained guidelines author Dr. Paul James, head of the department of 
> family medicine at the University of Iowa Carver College of Medicine.

> "We really couldn't see additional health benefits by driving blood 
> pressure lower than 150 in people over 60 [years of age]," James 
> explained. "It was very clear that 150 was the best number."

> The American Heart Association (AHA) and the American College of 
> Cardiology (ACC) did not review the new guidelines, but the AHA has 
> expressed reservations about the panel's conclusions.

> "We are concerned that relaxing the recommendations may expose more 
> persons to the problem of inadequately controlled blood pressure," said 
> AHA president-elect Dr. Elliott Antman, a cardiologist at Brigham and 
> Women's Hospital and a professor at Harvard Medical School in Boston.

> In November, the AHA and ACC released their own joint set of treatment 
> guidelines for high blood pressure, as well as new guidelines for the 
> treatment of high cholesterol that could greatly expand the number of 
> people taking cholesterol-lowering statins.

> About one in three adults in the United States has high blood pressure, 
> according to the U.S. National Heart, Lung, and Blood Institute.

> The institute formed the Eighth Joint National Committee, or JNC 8, in 
> 2008 to update the last set of high blood pressure treatment 
> guidelines, which were issued in 2003.

> In June 2013, the institute announced that it would no longer 
> participate in the development of any clinical guidelines, including 
> the blood pressure guidelines nearing completion.

> However, the announcement came after the institute had reviewed the 
> preliminary JNC 8 findings. The JNC 8 decided to forge ahead and finish 
> the guidelines.

> The recommendation to start seniors on medication at a higher blood 
> pressure reading is based both on evidence of the medical benefit as 
> well as concern over potential drug interactions and high drug costs, 
> James said.

> "The elderly are more likely to have other diseases that require 
> medication. It's not uncommon for me to see people who are on 10 
> different medications for various illnesses," he said. "If we don't see 
> evidence of improved health benefits, then the question becomes why add 
> those additional medicines?"

> The definition of high blood pressure -- anything above 140/90 -- 
> remains the same under the new guidelines, James said. Lifestyle 
> changes should be used to treat people who have high blood pressure 
> readings that fall below the level where medicine is needed, he explained.

> The panel also recommended a "toolbox" of four different blood pressure 
> medications that doctors could use treat patients -- diuretics, calcium 
> channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or 
> angiotensin receptor blockers (ARBs).

> "It gives options for physicians to begin treatment, and all classes 
> have generic versions available," James said. "This is a slight 
> difference from JNC 7, where they preferred the diuretic class as the 
> preferred first choice. We didn't see significant differences between 
> the four classes at improving health outcomes."

> James emphasized that these are treatment guidelines for doctors. 
> "Patients should not read these guidelines and take themselves off 
> medications," he said. "These are recommendations that are intended for 
> physicians who are highly trained professionals and will adapt them to 
> individual patients' needs."

> The JNC 8 reached its conclusions after reviewing more than 30 years of 
> clinical studies. However, the AHA is concerned that those studies 
> could not have assessed the full damage of long-term high blood pressure.

> "The adverse effects of high blood pressure on a person's health may 
> take many, many years to develop, longer than the follow-up period of 
> many of the trials included in the evidence review," Antman said.

> Epidemiologic evidence has shown that a lower blood pressure is 
> associated with lower rates of strokes, heart failure and death, he added.

> The guidelines issued by the AHA and the ACC call for lifestyle changes 
> to treat people with a systolic pressure of 140 to 159 and a diastolic 
> pressure of 90 to 99. Blood pressure levels greater than those should 
> be treated by a combination of medication and lifestyle changes. 
> Treatment would continue as long as the person had blood pressure 
> higher than 140/90.

> Even though the JNC 8 guidelines were not reviewed by the AHA or the 
> ACC, the expert panel has provided enough transparency that its 
> recommendations should be taken seriously, said Dr. Harold Sox, of the 
> Dartmouth Institute for Health Policy and Clinical Practice.

> "They laid the evidence out in a really crystal clear way, and were 
> really careful to make recommendations you could trace back to the 
> evidence without asking, 'How did they come up with that?'" Sox said.

> "Even though they didn't send the guidelines to AHA and ACC, their 
> documentation of the review process was so thorough that I, for one, 
> was convinced they couldn't have learned anything more than what was 
> learned in the initial review process," Sox added.

> Dr. Curtis Rimmerman, a staff cardiologist at the Cleveland Clinic in 
> Ohio, said he will weigh the new recommendations in his future 
> treatment decisions.

> "I'm going to have to go along with what I think are responsible people 
> doing responsible acts," he said. "I don't think it's going to change 
> my practice very much, but I want to digest this information further. 
> In some patients, I may relax some of my blood pressure goals, 
> particularly among more elderly patients who are taking many medications."



> Nancy Matulis

> ACB Maine Secretary

> Sent from my iPad
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