According to new guidelines announced by the American Heart Association and American College of Cardiology, high blood pressure should be treated sooner with lifestyle changes and in some patients with medication at a reading of 130/80 mm Hg rather than 140/90 mm Hg.
As a result, instead of one in three U.S. adults having high blood pressure (32%) with the previous definition, the new guidelines will result in nearly half of the U.S. adult population (46%) having high blood pressure.
The guidelines, which are the first update to offer comprehensive guidance to doctors on managing adults with high blood pressure since 2003, are designed to help people address the potentially deadly condition much earlier. High blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking.
“The intent of the guidelines is not so more prescriptions will be written, but rather for the purpose of early detection and prevention,” says Rob Greenfield, MD, cardiologist and director, non-invasive and preventive cardiology, and director, lipid clinics at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. “The new guidelines encourage a doctor and patient discussion if their blood pressure is elevated and directs the patient to eat healthier, exercise more, and possibly reduce salt intake. With more than one-third of the U.S. population being overweight, a risk factor for high blood pressure, these conversations are badly needed.”
Impact on medication utilization
Stage 1 hypertension (either a systolic reading of 130 to 139 mm Hg or a diastolic reading of 80 to 89 mm Hg) will not result in prescribing medication, except in those patients with previous cardiac events or those at high risk for future events without pre-existing cardiac disease, adds Robert L. Gillespie, MD, cardiologist, Sharp Rees-Stealy Medical Group, San Diego. There is clear data that patients are at increased risk of cardiac events starting at 115/75 mm Hg; it is a doctor’s obligation to let patients know that risk exists.
The majority of Americans that require pharmacologic intervention will be those who are already taking medication for hypertension, says Kurt W. Kaulback, MD, FACC, clinical director, Cardiovascular Services, Inspira Health Network; and interventional cardiologist, Inspira Medical Group Cardiovascular Services, both located in Mullica Hill, New Jersey. Particular attention should be paid to individuals with a history of cardiac and cerebrovascular complications of hypertension such as congestive heart failure, stroke, and heart attack.
The impact of the new guidelines is expected to be greatest among younger people. The prevalence of high blood pressure is expected to triple among men under age 45 and double among women under 45. “Again, the vast majority will receive lifestyle modification recommendations rather than additional medications, except for those who would truly benefit because of their high risk,” Gillespie says.
“Many payers with access to preventive health programs as part of their insurance products will get the opportunity to judge the strength of their initiatives,” says Kaulback. “It will be interesting to see if there is a cost associated with the increased use of these programs, and if that cost is passed on to consumers. Because most anti-hypertensive medications are available as generics, the cost impact could be minimal.”
Greenfield estimates the price of a cheap generic medication to be between $4 and $10 per month, which is insignificant compared to the hundreds of thousands of dollars spent on bypass surgery, hospitalizations, pacemaker and implantable defibrillators, and extended intensive care unit stays.
Gillespie believes that the long-term impact should actually save healthcare dollars by preventing disease early. “While there will be a modest increase in prescribed medications, the emphasis on recognizing elevated blood pressure in its early stages and treating those at higher risk has the potential to save many lives and to actually lower the impact of hypertension on society,” he says. “In the U.S., more cardiovascular disease deaths are attributed to hypertension than any other modifiable risk. These guidelines are a step in the right direction to lower that burden.”
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.