The new guidelines for categorizing patients with hypertension is causing blood pressure to rise among some experts involved in the debate.
Late last year, the American College of Cardiology, along with the American Heart Association, lowered the threshold for defining high blood pressure as well as the threshold for drug treatment in some patients.
Under the new guidelines, an additional 31 million people in the United States will be classified as having hypertension. Now, a report published in JAMA Internal Medicine says the new guidelines may be putting patients at risk.
Dr. Katy Bell, lead author of the report and a senior research fellow at the University of Sydney in Australia, says the new guidelines follow a general pattern across medical specialties, in which disease definitions are often widened rather than narrowed.
“Such widened definitions usually label people as unwell, even if they are at low risk of a disease, and thus have the potential to cause harm. All of the incremental benefits and harms of the expanded definition of hypertension don’t appear to have been considered when the new guidelines were drafted,” she told Healthline.
Bell’s report found 80 percent of people newly diagnosed with high blood pressure under the guidelines weren’t expected to get any benefit from the definition.
“We estimate that about 25 million Americans who are now labeled as hypertensive… will be at low risk of cardiovascular disease. We are not aware of any evidence that labeling such low-risk people as hypertensive offers them any benefit,” she said.
But Bell says it’s possible labelling such people as hypertensive could put them at risk of mental health problems.
“Labeling a person as having hypertension increases their risk of anxiety and depression, as compared to the risk for people with the same blood pressure who aren’t labeled as hypertensive,” she said.
Under previous guidelines, the threshold for diagnosing hypertension in adults was a reading of 140/90 mmHg (a blood pressure reading of 140 over 90). Under the new guidelines, the threshold is lowered to 130/80.
Diagnosis may spur action
Dr. Matthew Budoff is a professor of medicine at the David Geffen School of Medicine at the University of California Los Angeles (UCLA) as well as the program director of the Division of Cardiology at the Harbor-UCLA Medical Center.
He says although raising awareness about hypertension and setting a goal of a blood pressure reading less than 130/80 is important, the new definitions might not be suitable.
“I think the label and definition of hypertension at 130/80 is not appropriate. Too many patients will have a value above 130 and be labeled. I don’t think it causes harm, but it is both unnecessary and may lead to higher premiums for insurance and more difficulty getting insured,” he told Healthline.
Despite this, Budoff says the benefits to the 31 million Americans now labeled as hypertensive far outweigh the risks. He says sometimes it takes a diagnosis to spur people into action.
“I think more people react positively with a diagnosis of something. I have several patients this week that were recently diagnosed with borderline diabetes, and they immediately started losing weight, eating better, and watching their fat/carb intake,” he said.
The potential changes a person may make from a diagnosis of hypertension could be beneficial.
“By far, the benefits outweigh the risks. More lifestyle changes, salt restriction, exercise, weight loss will lead to better outcomes and healthier lives for all. There is no data at all that would suggest any of these lifestyle changes would decrease life expectancy, nor any data at all that any medication has more harm than good. If meds had more harm than good, the FDA would never allow their use,” he said.
Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center, says implementing the guidelines would lead to significant benefits for men and women of all ages.
“Reductions in heart attacks, strokes, heart failure, renal failure, and premature cardiovascular deaths. The benefits greatly outweigh any potential risks,” he told Healthline.
Fonarow disagrees with Bell’s assertion that 80 percent of people newly diagnosed with hypertension would get no benefit from such a diagnosis.
“Individuals with elevation in blood pressure in the range classified in the new guidelines as hypertension are at increased risk for cardiovascular events, and this risk is modifiable. There are important proactive steps that can be taken to lower this risk through lifestyle modification,” he said.
“There is clear and compelling benefit of lowering blood pressure to the levels recommended in the new guidelines in all age groups and in men and women. The JAMA Internal Medicine analysis is misleading and does not consider the long-term benefits of achieving and maintaining recommended blood pressure levels,” he said.
The Centers for Disease Control and Prevention (CDC) reports that 360,000 people in the United States die annually from hypertension. That’s nearly 1,000 deaths a day.
Fonarow says the biggest risk is not from overdiagnosing but underdiagnosing.
“There are hundreds of thousands of hospitalizations, and tens of billions of dollars of expenditures as a direct result of not diagnosing, treating, and controlling hypertension according to the guidelines. This is the clear, present, and ongoing danger to the healthcare system,” he said.