New Research - New Recommendations for Blood Pressure
Over the years, our medical guidelines often change as new research emerges, giving doctors updated information. In the Fall of 2017, new research was published regarding blood pressure. We will go over the pathology of blood pressure, the risks of hypertension, the new guidelines, and the controversy the new guidelines have stirred up.As nurses, learning how to take a blood pressure is one of the first skills we learn. We are very familiar with the numbers, knowing immediately if the numbers are too high, or too low. It never hurts to review exactly what is happening behind those numbers.
Pathology of Blood Pressure
The measurement of blood pressure is the velocity of blood pressing against the walls of our arteries. The greater the pressure, the harder the heart has to work. Untreated high blood pressure can cause a lot of damage to our hearts, kidneys, brain, lungs and blood vessels. The top number - (systolic) represents the heart beat, while the bottom number -(diastolic) represents the heart at rest (the refilling of the heart with blood).
Symptoms of hypertension can be severe headache, nose bleeds, and shortness of breath. However, some patients may not feel any symptoms, garnering hypertension the title of silent killer.
Risks of Hypertension
Hypertension is one of those conditions that some patients have the power to decrease their risk factors. In the guideline, "Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults", by Paul K. Whelton, MB, MD, MSc, FAHA, they share that in 2010, hypertension was at the top of the list for causing disability and death. "In the United States, hypertension accounted for more CVD deaths than any other modifiable CVD risk factor and was second only to cigarette smoking as a preventable cause of death for any reason".
Often those with hypertension may have other CVD risk factors. For example, current smokers, obesity,diabetes, hypercholesterolemia, and chronic kidney disease. Controlling cholesterol and being compliant with kidney treatment are ways to decrease a patient's risk of CVD. Smoking and obesity are some risk factors that the patient is accountable for. As in almost every other disease process, diet and exercise improve the body's ability to fight disease. What we eat is directly related to our health.
There are risk factors that the patient can't necessarily change. There is a strong correlation with hypertension and genetics. We have all seen patients diagnosed early in life with hypertension and when we ask them about family, almost always they have a strong family history. As we grow older, the higher the chance for us being diagnosed with hypertension. Males have a greater percentage of hypertension than females, along with those who have obstructive sleep apnea, and high levels of stress.
Another factor that is out of the control of the patient, is the ethnic group we are born into. Those at the highest risk are African-American and Hispanics. Whites and Asian patients come next. Hypertension is sometimes diagnosed with one reading at the doctor office, resulting in over diagnosing of the disease. Rather, it should be based on the average from several visits, combined with the patient keeping a log at home.
New Blood Pressure Guidelines
The article by the American College of Cardiology broke down Whelton's research in their article, "New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension". The approach of treatment lowers the range of blood pressure from 140/90 to 130/80. The focus is to treat earlier, modify risk factors and use a preventative approach to lowering patient's risks to debilitating disease or even death.
This new set of numbers will lead to an increase of "46 percent" of the population being diagnosed with high blood pressure. This will affect men under the age of 45 the most (it will triple the men diagnosed), and double the amount of women under 45 who will be treated for hypertension. Again, the objective is early detection, early treatment. However,treatment isn't always in the form of medication.
New Guidelines taken from the American College of Cardiology article:
Normal: Less than 120/80Elevated: Systolic between 120-129 and diastolic less than 80Stage 1: Systolic between 130-139 or diastolic between 80-89Stage 2: Systolic at least 140 or diastolic at least 90.
Other recommendations - only prescribe medication for Stage 1 if the patient already has had a heart event such as heart attack/stroke. Sometimes patients will need more than one medication to control their blood pressure, and combination drugs increase compliance. The third recommendation is for doctors to recognize that socioeconomic and psychosocial stress play a role in risk factor for hypertension and should be part of the plan of care.
The new guidelines were developed by a large panel of professionals. Nine health professional organizations were involved, and then written by 21 scientists and health experts all who reviewed over 900 published studies.
Controversy Over New Guidelines
The American College of Physicians had several reasons that they did not care for the new guidelines. First, it would put a lot of people at an earlier age on a daily medication where they state, "adverse events could outweigh the benefit". They tell us that it would increase the number of adults on hypertension medication by 4.2 million. Other concerns are the cost to patients, potential in lack of individualized care, and overburdening the doctors with managing these patients.
Sometimes change can be difficult. It remains to be seen how this new guideline effects our statistics regarding hypertension and prevention. Have you had a doctor use this new guideline? Have you heard them discuss it, if so, tell us what you have learned about how they feel about it.
Darrah, Joe. "AHA Guidelines Causing Controversy". Jan. 19, 2018. Advance healthcarenetwork. Web.Feb. 27, 2018.
"New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension." Nov. 13, 2017. American College of Cardiology. Web. Feb. 27, 2018
Whelton, PK. et al. "2017 ACC/AHA/AAPA/ACPM/AGS/APhA/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults". 2017. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Web. Feb. 27, 2018.Last edit by Joe V on Jun 14
About Brenda F. Johnson, BSN, RN
Joined: Oct '14; Posts: 229; Likes: 838
RN at Gi Lab; from TN , US
Specialty: 25 year(s) of experience in Gastrointestinal NursingMay 3Joined: Jan '10; Posts: 2,278; Likes: 9,426It is pretty clear how these new guidelines will affect stats. If you make your criteria wider, prevalence will increase. That's the law of math, there is no way around it.
Then, the following will happen:
1). Nobody deleted the Overtone window - what is seen commonly, earlier or later becomes to be seen as a norm of a kind. Therefore, patients will see that everyone around them seems to "get pressure"- and they stop care for it altogether.
2). Nobody added some hours to the worktime of already stretched thin primary care providers to discuss non-pharmacologic strategies.
3). The said non-pharmacologic strategies present stark contrast with what is just real life for most Americans. Too many of them can't, or won't, invest significant efforts in breaking their lifestyles down to ground for something they MIGHT benefit from in 30/40/50 years.
4). Being, on average, smart and time-strapped, the aforementioned primary care providers won't invest any time or efforts over what they already doing for performing actions which make no sense and just ignore these guidelines like they do with many others.
I asked several cardiologists what they think about all that. They answered, but I cannot post their answers here as 90% of them contained language they probably learned in ORs, and not at the best moments there.