Health Professionals > Physicians > Professional Resources > Medical News
NHLBI Issues New Report
on
Americans' Overall Physical Activity Levels |
 |
|
|
The National Heart, Lung, and Blood Institute (NHLBI) today
released new clinical practice guidelines for the
prevention, detection, and treatment of high blood
pressure. The guidelines, which were approved by the
Coordinating Committee of the NHLBI's National High Blood
Pressure Education Program (NHBPEP), feature altered blood
pressure categories, including a new "prehypertension"
level-which covers about 22 percent of American adults or
about 45 million persons.
The new guidelines also streamline the steps by which
doctors diagnose and treat patients, and recommend the use
of diuretics as part of the drug treatment plan for high
blood pressure in most patients.
Called "The Seventh Report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure," the guidelines will appear in the May 21,
2003, issue of "The Journal of the American Medical
Association" ("JAMA"). But, due to their importance, they
will be available on May 14, 2003, on the "JAMA" Web site
(http://jama.com) in an expedited version.
The guidelines were prepared by a special committee of the
NHBPEP, which represents 46 professional, voluntary, and
Federal organizations, and reviewed by 33 national
hypertension experts and policy leaders. The NHBPEP issues
new guidelines when warranted by scientific advances. The
last guidelines were issued in November 1997.
"Since 1997, much more has been learned about the risk of
high blood pressure and the course of the disease," said
NHLBI Director Dr. Claude Lenfant. "Americans' lifetime
risk of developing hypertension is much greater than we'd
thought. For instance, those who do not have hypertension
at age 55 have a 90 percent risk of going on to develop the
condition.
"We also now know that damage to arteries begins at fairly
low blood pressure levels-those formerly considered normal
and optimal," he continued. "In fact, studies show that the
risk of death from heart disease and stroke begins to rise
at blood pressures as low as 115 over 75, and that it
doubles for each 20 over 10 millimeters of mercury (mm Hg)
increase. So the harm starts long before people get
treatment.
"Unless prevention steps are taken, stiffness and other
damage to arteries worsen with age and make high blood
pressure more and more difficult to treat. The new
prehypertension category reflects this risk and, we hope,
will prompt people to take preventive action early."
"The past six years have brought results from more than 30
clinical studies worldwide, many of which were funded by
the NHLBI," said Dr. Aram V. Chobanian, Dean of Boston
University School of Medicine in MA and Chair of the Joint
National Committee that produced the new guidelines. "These
findings have been remarkably consistent in demonstrating
the critical importance of lowering blood pressure,
irrespective of age, gender, race, or socio-economic
status. The data allow us to create a set of
recommendations that are easier to use than past
guidelines, which should in turn make it easier for
clinicians to treat their patients' hypertension."
High blood pressure is a major risk factor for heart
disease and the chief risk factor for stroke and heart
failure, and also can lead to kidney damage. It affects
about 50 million Americans-one in four adults. Treatment
seeks to lower blood pressure to less than 140 mm Hg
systolic and less than 90 mm Hg diastolic for most persons
with hypertension (less than 130 systolic and less than 80
diastolic for those with diabetes and chronic kidney
disease).
The guidelines include new data on U.S. control, awareness,
and treatment rates for high blood pressure. According to a
national survey, 70 percent of Americans are aware of their
high blood pressure, 59 percent are being treated for it,
and 34 percent of those with hypertension have it under
control. Those percentages represent a slight improvement
over rates for 10 years ago, when 68 percent of Americans
were aware of their high blood pressure, 54 percent were
being treated for it, and 27 percent of those with
hypertension had it under control. By contrast, about 25
years ago, 51 percent were aware of their high blood
pressure, 31 percent were being treated, and 10 percent of
those with hypertension had it under control.
"Though improved, the treatment and control rates are still
too low," said Chobanian. "The new guidelines zero in on
this problem, recommending factors that often lead to
inadequate control such as not prescribing sufficient
medication. The guidelines stress that most patients will
need more than one drug to control their hypertension and
that lifestyle measures are a crucial part of treatment.
"Another key factor is the need for clinicians to pay more
attention to systolic blood pressure in those age 50 and
older," he continued. "From mid-life on, systolic
hypertension is a more important cardiovascular risk factor
than diastolic. It's also much more common and harder to
control."
Key aspects of the new guidelines include:
-- A new "prehypertension" level and merging of other
categories. The new report changes the former blood
pressure definitions to: normal, less than 120/less than 80
mm Hg; prehypertension, 120-139/80-89 mm Hg; stage 1
hypertension, 140-159/90-99 mm Hg; stage 2 hypertension, at
or greater than 160/at or greater than 100 mm Hg. The 1997
categories were optimal, normal, high-normal, and
hypertension stages 1, 2, and 3.
"Stages 2 and 3 were combined because their treatment is
essentially the same," said Chobanian. "The new
prehypertension category should alert people to their real
risk from high blood pressure."
The guidelines do not recommend drug therapy for those with
prehypertension unless it is required by another condition,
such as diabetes or chronic kidney disease. But the report
advises them -- and encourages those with normal blood
pressures -- to make any needed lifestyle changes. These
include losing excess weight, becoming physically active,
limiting alcoholic beverages, and following a heart-healthy
eating plan, including cutting back on salt and other forms
of sodium. The report also recommends that, for overall
cardiovascular health, persons quit smoking.
As in the 1997 guidelines, the new report recommends
Americans follow the DASH -- Dietary Approaches to Stop
Hypertension -- eating plan, which is rich in vegetables,
fruit, and nonfat dairy products. Clinical studies have
shown that DASH significantly lowers blood pressure. The
decreases are often comparable to those achieved with blood
pressure-lowering medication.
-- Simplified and strengthened drug treatment
recommendations. The guidelines recommend use of a
diuretic, either alone or in combination with another drug
class, as part of the treatment plan in most patients. The
report notes that even though many studies have found
diuretics to be effective in preventing hypertension's
cardiovascular complications, they are currently not being
sufficiently used.
The guidelines also list other drug classes that have been
shown to be effective in reducing hypertension's
cardiovascular complications and that may be considered to
begin therapy: angiotensin converting enzyme (ACE)
inhibitors, angiotensin receptor blockers, beta-blockers,
and calcium channel blockers. The report also gives the
"compelling indications" -- or high-risk conditions -- for
which such drugs are recommended as initial therapy.
-- Use of additional drugs for severe hypertension or to
lower blood pressure to the desired level. According to the
new report, most persons will need two, and at times three
or more, medications to lower blood pressure to the desired
level.
-- The guidelines also recommend clinicians work with
patients to agree on blood pressure goals and develop a
treatment plan.
"No treatment will work unless patients stay on it, no
matter how careful the clinician," said NHBPEP Coordinator
Dr. Ed Roccella. "The guidelines incorporate information
from behavioral studies and offer advice to clinicians on
how to motivate patients to stick with their treatment.
It's crucial to build trust and make sure patients
understand their treatment and feel able to voice their
concerns."
To raise awareness about the dangers of high blood pressure, NHLBI is developing
special Web pages and educational materials for health care professionals, patients,
and the public. These include an updated "Your Guide To Lowering High Blood
Pressure" Web page, which can be found at http://www.nhlbi.nih.gov/hbp.
"The bottom line is that Americans must change how they
think about blood pressure," said Roccella. "The sooner
they take action, the better. It's vital that they adopt a
heart-healthy lifestyle early, even if their blood pressure
is normal.
"May is National High Blood Pressure Education Month, a
good time for people to take stock of their heart health --
along with the steps necessary to protect it," he added.
Information and resources regarding National High Blood Pressure Education Month
are available at www.nhlbi.nih.gov/hbp/index.html.
The guidelines and related information are available at www.nhlbi.nih.gov/guidelines/hypertension/index.htm.
To interview an NHLBI spokesperson about the new guidelines, call the NHLBI
Communications Office at (301) 496-4236. To interview Dr. Chobanian, call Gina
DiGravio at the Boston University School of Medicine's Corporate Communications
Office at (617) 638-8491.
|
