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New guidelines released for management of high blood pressure


      New national guidelines for treating high blood pressure were formulated by a panel that included VA researcher Dr. William Cushman.
New national guidelines for treating high blood pressure were formulated by a panel that included VA researcher Dr. William Cushman. (Photo by April Eilers)

New national guidelines for treating high blood pressure were formulated by a panel that included VA researcher Dr. William Cushman. (Photo by April Eilers)

A new guideline for managing high blood pressure, developed by an expert panel and containing nine recommendations and a flow chart to help doctors plan treatment, was recently published in the Journal of the American Medical Association (JAMA).

William C. Cushman MD , chief of preventive medicine at the Memphis VA Medical Center and VA's lead consultant on hypertension, is a member of this panel, and was a coauthor of the panel's report. Dr. Cushman is also professor of preventive medicine, medicine, and physiology at the University of Tennessee Health Sciences Center. He is a past recipient of VHA's John Blair Barnwell Award for outstanding achievement in clinical science.

Dr. Cushman is currently leading a network of 20 VA sites in a six-year National Institutes of Health-funded study, called the Systolic Blood Pressure Intervention Trial (SPRINT). The goal is to determine whether reducing systolic blood pressure to a lower goal than is currently recommended can reduce the risk of vascular disease.

The new guideline report contains a major revision of hypertension treatment targets, and includes new and somewhat simplified recommendations for drug treatment. Previous guidelines recommended that all adults have a target systolic blood pressure below 140 mm Hg, and that those with diabetes or kidney disease have an even lower target, less than 130 mm Hg.

The new guideline keeps the same target for adults under 60, but eliminates the lower target for those with diabetes or renal disease. For people over 60, the new guideline establishes a more conservative target of 150 mm Hg or lower. This does not change the definition of hypertension, which is 140 mm Hg systolic pressure and 90 mm Hg diastolic pressure, because the authors believe lower is still better when it occurs naturally—but the recommendations are based on a lack of evidence showing that drug treatment to the lower levels is better.

The guidelines also provide recommendations on the kinds of drug treatments physicians should use in treating hypertension. If the target blood pressure is not achieved after a month, the guideline recommends increasing the drug dose or adding a second drug. Blood pressure should be monitored until the treatment goal is reached. (Journal of the American Medical Association, Feb. 5, 2014)



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