TO try to better align treatment goals with the best available evidence, a panel of experts recently revisited national high blood pressure guidelines - their conclusions offer a few tweaks directed especially at older adults and those with diabetes and kidney disease, says the Mayo Clinic Health Letter.

Well over half of adults older than 65 and closer to 80 percent of those older than 75 have high blood pressure - between a third and half of these adults have uncontrolled high blood pressure which means it’s not being treated adequately or at all, adds the health letter.

High blood pressure, a common yet serious health problem in the U.S., can lead to significant health risks, including heart attack, stroke, heart failure, kidney failure and other organ damage.

Your blood pressure is the amount of force exerted on your artery walls to keep your blood flowing.

Several organs and body chemicals work together to help control your blood pressure and keep it from rising too high or falling too low.

They include your heart, arteries and kidneys, and other factors, such as your central nervous system and various hormones and enzymes.

Too much pressure may build up within your arteries, when the complex system regulating your blood pressure doesn’t work as it should - when the increased pressure in your arteries persist, your doctor may diagnose you as having high blood pressure.  

Although for some, high blood pressure tends to develop over many years without an exact cause, for others, an underlying condition causes high blood pressure - examples are kidney or thyroid disease and certain medications.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers: a) The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure); b) The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Normal blood pressure is considered to be less than 120/80 mm Hg.

High blood pressure means you have high readings on a persistent basis - that means systolic blood pressure is consistently 140 mm Hg or higher, diastolic pressure is consistently 90 mm Hg, or both.

Isolated systolic hypertension - when diastolic pressure is normal but systolic pressure is high - is a common type of high blood pressure among individuals older than 60.

The goal of treating high blood pressure is to maintain it within a range that will prevent damage to your arteries, as well as organs, such as your heart, kidneys and brain.

To help them determine how to treat high blood pressure effectively, many doctors rely on a set of guidelines which have evolved over the years to reflect expert opinion and the latest available evidence.

The most recent guidelines, from the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure were published in 2014: the results refined previous guidelines in three key ways, namely:

• Target goals for older adults - For healthy adults 60 or older, the latest treatment recommendation is to strive for a goal of 150/90 mm Hg - this is slightly higher than the previous guideline, which recommended a more aggressive goal of 140/90 mm Hg for everyone with high blood pressure, regardless of age.

Clinical trials haven’t shown that the more aggressive goal is beneficial.

However, the new goal doesn’t mean you have to change your current treatment if it lowers your blood pressure to less than 140/90 mm Hg - as long as you’re not experiencing any side effects, there’s no need to adjust your medication.

• Target goals for individuals with diabetes or kidney disease - Previously, the blood pressure goal for those with diabetes or kidney disease was 130/90 mm Hg.

Current guidelines recommend that these individuals strive for the same goal as everyone younger than 60 with high blood pressure - 140/90 mm Hg.

As with the recommendation for older adults, the committee members based this decision on finding no substantial evidence that treating to a lower target is helpful.

• Preferred medication options - In the past, thiazide type diuretics were preferred as first line therapy.

The new guidelines recommend four different classes of blood pressure medications.

To summarize the refined current guidelines: If you have high blood pressure, evidence-based guidelines advise keeping your blood pressure lower than:

• 150/90 mm Hg if you’re a healthy adult 60 or older

• 140/90 mm Hg if you’re a healthy adult younger than 60

• 140/90 mm Hg if you have diabetes or kidney disease

One of the underlying principles of the new guidelines is that more aggressive treatment isn’t always better at improving health, nor is it backed by solid evidence, especially in the case of older adults and those with diabetes or chronic kidney problems.

Also, less aggressive goals reduce the intensity of treatment which also makes for fewer side effects.

At the same time, keep in mind your health is a unique combination of genes, environment and physical and biological attributes - thus, you should work with your doctor and other members of your health care team to develop a treatment plan that’s suited to your specific situation.

Together, you and your doctor can decide on your treatment goal and medications so that they fit your lifestyle, give you good quality of life, and help you reduce your risk of heart disease, stroke and other consequences of high blood pressure, concludes the health letter.

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