New blood pressure guidelines: I'm ignoring them

The American Heart Association and American College of Cardiology are now recommending new blood pressure guidelines for anyone who has at least a 10 percent risk of a heart attack or stroke in the next decade. (Apparently simply being 65 or older puts you in that category.) Now high blood pressure is defined as 130/80, down from 140/90. This new level means that nearly half of all American adults and nearly 80 percent of those 65 and older will be considered to have high blood pressure, and, presumably, to need medication for it.

Dr. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is my go-to guy for sensible advice. While he acknowledges that very high blood pressure is dangerous and should be treated, he questions the new guidelines—not only the numbers also the study that produced the guidelines.

For one thing, he notes that blood pressure is an “exceptionally volatile biologic variable,” meaning that it varies depending on what you’re doing, your stress level, and your surroundings. My blood pressure is always high in a doctor’s office—a common phenomenon called the “white coat syndrome.” I’ve tested my blood pressure at home and have also noticed that it varies from time to time. I just sit there testing until it reaches a level I like.

Welch says that “a national goal of 130 as measured in actual practice may lead many to be over-medicated—making their blood pressure too low. More medications and lower blood pressures are not always better for everyone.”  For one thing, he thinks that lowering blood pressure by too much makes people lightheaded and leads to falls and fractures. Moreover, intensive drug treatment in so many more patients may increase the rates of kidney disease. (In the trial, incidence of acute kidney injury was twice as high in the group receiving drugs to reduce their blood pressure to 120).

I may be sorry, but I’m just ignoring the whole business and still not taking blood pressure meds, even though I have a ten percent chance of having a heart attack or stroke—probably higher at age 81.

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