Feinstein scientist challenges ‘aggressive’ BP guides

Aggressive tendencies: New American Heart Association-approved guidelines on the treatment of high blood pressure may be doing more harm than good for some patients.
By GREGORY ZELLER //

New American Heart Association guidelines redefining “high blood pressure” are harming some patients, according to a Feinstein Institute researcher and other scientists.

Findings published online Wednesday in the Journal of the American College of Cardiology challenge new, stricter guidelines issued in November 2017 by the AHA, the American College of Cardiology and nine other professional health organizations.

Those guidelines – written by a panel of 21 scientists and health experts who reviewed more than 900 published studies – reset the hypertension threshold at a blood-pressure reading of 130 over 80 mm Hg, rather than the previous 140 over 90. By those numbers, 46 percent of American adults are now considered hypertensive, up from 32 percent.

But according to Feinstein Institute for Medical Research investigator Joseph Diamond and five other authors of “Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension,” the new guidelines don’t simply move the hypertension line of scrimmage.

Joseph Diamond: No pressure.

While they do benefit patients at higher risk for cardiovascular disease, the revamped guidelines also do more harm than good for lower-risk patients – with as many as 10 million “unnecessarily aggressive blood-pressure treatments” prescribed based on the new numbers, according to the Feinstein Institute.

Working off tables predicting 10-year risks for cardiovascular disease, the researchers found that aggressive blood-pressure treatment of patients with a risk factor of 18.2 percent or greater would result in more benefit than harm, while those with a lower risk percentage would fare better with standard pressure-management protocols.

The new guidelines suggest aggressive treatments for patients with risk factors of 10 percent or greater.

Diamond, director of nuclear cardiology at the Long Island Jewish Medical Center and a Fellow of the American Society of Hypertension, said the data has convinced him and his colleagues to steer away from the new guidelines.

“My colleagues and I recommend using a different model for patients with high blood pressure than what was most recently recommended,” the doctor said Wednesday. “Identifying patients by degree of future cardiovascular risk identifies those who will most benefit from intensive blood-pressure treatment goals.

“We do not feel that aggressive blood-pressure lowering is warranted in all individuals,” Diamond added.