Changing B/P numbers?

[handyrn]

I work for a company sometimes doing health counselling. One of the things we do is b/p. The information that I am to give them (and the accompanying pamphlet) says that b/p should be LESS THAN 120/80. When I went to nursing school, we were taught that 120/80 is perfect b/p but some people run a little over (or under) that and that it is perfectly normal for them if there b/p is consistently at that rate. (Up to a point.) For example, if Mrs. Jones' b/p runs 132/84 ALL the time, that is normal for her, and thus, ok. What this pamphlet is saying is that 120/80 is pre-hypertensive and that you should strive to get that number lower. Has this changed? Is it normal now to tell people that 120/80 is too high?

[KellyRPNinOntario]

I was also taught 110/70.

[coast2coast]

Coast2Coast - It depends on the patient, which is why we need to tailor to their needs. For instance, if someone has a co-morbidity of hyperthyroidism, we may expect clinically that not only is their BP going to be a little on the high side but their heart rate will be as well. It doesn't necessary mean they have heart disease. The same goes with someone who has had an MI in the past, is on beta-blockers and their BP is now reading 70/50. It doesn't mean they DON'T have heart disease, it means their meds are working.

This is why we look at a patient as a whole and not just one assessment factor.

I agree with your basic rationale, but - Wouldn't you still treat the hypertension? Even if they currently are asymptomatic, they are still at risk for cardio problems caused by HTN.

Particularly with hyperthyroid pts, I was under the impression that they routinely got beta blockers in addition to PTU or other thyroid drugs. Isn't that an example of treatment based solely on high BP in the absence of any symptoms of heart disease?

[CBsMommy]

I agree with your basic rationale, but - Wouldn't you still treat the hypertension? Even if they currently are asymptomatic, they are still at risk for cardio problems caused by HTN.

Particularly with hyperthyroid pts, I was under the impression that they routinely got beta blockers in addition to PTU or other thyroid drugs. Isn't that an example of treatment based solely on high BP in the absence of any symptoms of heart disease?

I think there are some hyperthyroid patients that do get beta blockers but I think it's mostly to treat the heart rate (some people with Grave's disease feel heart palpitations) and not necessarily the BP. It's the doctor's call though.

I will also add that I've seen people with HTN come into the office with a 150/90, who were in great physical shape and of a younger age and the doctor didn't care to treat the HTN because that particular patient's profile didn't call for it. So, again, it just depends on the patient.

[regularRN]

Or are the recommended systolic and diastolic BPs becoming progressively lower because it means that more anti-hypertensives can be prescribed, thereby increasing Big Pharma revenue?

Not saying I agree with this, just wondering....

[linearthinker, DNP, RN]

You should be using JNC-7 guidelines, which state the risk of CVD beginning at 115/75 doubles w/ each increment of 20/10. Treatment begins at 120/80 or greater.

[linearthinker, DNP, RN]

I think there are some hyperthyroid patients that do get beta blockers but I think it's mostly to treat the heart rate (some people with Grave's disease feel heart palpitations) and not necessarily the BP. It's the doctor's call though.

I will also add that I've seen people with HTN come into the office with a 150/90, who were in great physical shape and of a younger age and the doctor didn't care to treat the HTN because that particular patient's profile didn't call for it. So, again, it just depends on the patient.

Not treating 150/90 amounts to medical malpractice.