There is an ongoing controversy between cardiologists and internists/family practice docs about what is the optimum blood pressure in adults. Until recently, a target of 140 mm/Hg systolic or below in all adults and 150 in those over age 60 has been the consensus. Now, based on the recent SPRINT study, the American College of Cardiology and the American Heart Association have issued new guidelines setting the upper limit of normal to 130. This means that nearly half of all adults in the US (105 million people, up from 74 million before) would be diagnosed with hypertension and prescribed medication. Other doctors disagree.
“That is a lot of people and that label is not benign — it has serious consequences,” one family practice doctor commented. “It can affect their medical insurance and their life insurance, and I don’t think it is justified by the science. The SPRINT trial was a selective group — the vast majority were higher-risk patients already taking antihypertensive medications. They have extrapolated this data to the group at low risk with systolic pressures in the 130 to 140 range without treatment. We don’t have the science to support that.”
I agree with him. In fact, when I looked at the SPRINT study, I found that the difference in serious heart disease or death between those treated to a target of less than 140 versus 120 was less than 1 percent. Those in the lower blood pressure group had three times the incidence of kidney damage and twice the level of serious adverse effects such as fainting. Mental functioning, which can be impaired at lower blood pressures, was not evaluated in the study.
A different study, cited in my book, reported that people with systolic pressures between 130 and 139 and diastolic pressures between 60 and 79 had fewer deaths from all causes and less kidney failure than those above or below those values. Those with a systolic of 110 to 119 had twice the incidence of deaths and kidney failure. But a blood pressure over 150 increases these risks as well.
So why does the American Heart Association recommend lowering blood pressure to these lower levels? Could it be because they receive millions in funding from the pharmaceutical companies that make the medications? Could it be because several of the members of the advisory panel issuing the recommendations receive research grants and consulting fees from the same companies? You tell me.
One final point, also covered in my book, is that one blood pressure reading taken in the stressful atmosphere of a doctor’s office does not accurately reflect your actual day-to-day reading. Experts recommend that blood pressure be taken after sitting quietly for five minutes with both feet on the floor three times in a day to determine the actual value.