- New Hypertension Guidelines
Dr. Paul Whelton and a large number of experts in hypertension have recently published new guidelines for the treatment and prevention of hypertension. These guidelines have been published in many scientific journals and the media has covered this release extensively. The new guidelines replace JNC-7 guidelines. Why are the new guidelines getting so much attention?
The new guidelines lower and change the definition of hypertension. The new blood pressure number is 130/70. If your blood pressure is above this, you have high blood pressure. This will increase those with high blood pressure to over 45% of the adult population. I was recently asked to present a perspective on hypertension at a cardiovascular symposium.
The new guidelines are just that, new guidelines. Our bodies were not designed to be exposed to prolonged high pressures in our arteries and organs. Pending our genetic make-up, this leads to damaged organs and the resulting problems such as heart attacks, stroke, aneurysms, kidney disease, dementia, organ dysfunction and the list goes on.
According to a study by the Health Care Cost Institute, those with high blood pressure spend three times more on health care than those without and about two times more on out of pocket. From 2012-2016 spending for those with hypertension grew 18.3 percent.
The new guidelines ask clinicians to define the measurement more accurately and assess risk. The recommendations also emphasize treating the cause of high blood pressure including the myriad of lifestyle factors including too much sodium, too much fat, inactivity, and stress.
One major problem persisting through all previous guidelines is that our culture does not reward lifestyle changes, nor do we stress the importance. There have been numerous guidelines and yet the problem, hypertension, continues to escalate. Clinician and patient education does not seem to be making a large enough impact. We must find a way to promote a reward system for the clinicians and patients who address cause.
Unfortunately, the economics and culture of modern medicine has evolved into, “let’s treat the symptoms and give a medication.” This is not a solution for this chronic symptom, the number one risk factor for death in the world.
The guideline is well written and researched. It does a great job on emphasizing the problem, stressing the importance of correct measurement, and identifying the pressure at an earlier stage, and intervening before the prolonged exposure causes damage. It stresses the importance of lifestyle changes and the need for pharmaceutical intervention for those at increased risk.
For a clinician who focuses on the “how to implement” and “practical steps” to aid in lifestyle intervention, the guidelines were a first step. Acknowledgement that lifestyle changes and earlier intervention is the key is an important first step. I am not sure this point was emphasized enough.
If the guidelines serve as an impetus to change the economic reward system, we may not continue to read about yet another guideline in the health media.
James L. Marcum MD FACC ACLM
Speaker/Director Heartwise Ministries
Chattanooga Heart Institute
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I want to focus on a few points today in this column. More than 64,000 died from overdoses last year. We as a society are becoming more and more dependent on medications. Medications are needed at times and they have a place, but as we see with the opioid crisis, we, in the health care world, need to look at the cause of problems.
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A few years ago I felt so strongly about the problem of deaths related to medication, I wrote the book, “Medicines that Kill”. This book was intended to give individuals another source to educate themselves. I still feel the number one cause of death in America is the misuse of medications. The opioid crisis is just more evidence. As this is such a problem, we need to continue to speak out in the media. Individuals need to hear other voices that have no financial interests in the industry.
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The New York Times has reported in November 2017 on a new study in the journal Lancet. This study found that while cardiac stents can be lifesaving in opening arteries in patients having a heart attack, the devices are ineffective in relieving chest pain.
Stents are tiny wire cages to open arteries. They are useful when patients are having heart attacks or unstable symptoms, however, they are often deployed when patients have no symptoms just blockages. More than 500,000 had stents placed last year. Stents do carry risk. They are expensive.
This study placed stents in some and had sham procedures in others. The study found no real difference in the groups who all had blockages and symptoms related to these blockages.
Of course, this has raised a bit of controversy in the cardiology world. There have long been questions regarding the effectiveness of stents. A 2007 study led by Dr. Boden and published in the New England Journal of Medicine found stents did not prevent heart attacks or deaths from heart disease. Yet stent procedures continue. Cardiovascular disease is not being cured by stent procedures.
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