Dr. Paul Whelton and a large number of experts in hypertension have recently published new guidelines for the treatment and prevention of hypertension. These guidelines have been published in many scientific journals and the media has covered this release extensively. The new guidelines replace JNC-7 guidelines. Why are the new guidelines getting so much attention?

The new guidelines lower and change the definition of hypertension. The new blood pressure number is 130/70. If your blood pressure is above this, you have high blood pressure. This will increase those with high blood pressure to over 45% of the adult population. I was recently asked to present a perspective on hypertension at a cardiovascular symposium.

The new guidelines are just that, new guidelines. Our bodies were not designed to be exposed to prolonged high pressures in our arteries and organs. Pending our genetic make-up, this leads to damaged organs and the resulting problems such as heart attacks, stroke, aneurysms, kidney disease, dementia, organ dysfunction and the list goes on.

According to a study by the Health Care Cost Institute, those with high blood pressure spend three times more on health care than those without and about two times more on out of pocket. From 2012-2016 spending for those with hypertension grew 18.3 percent.

The new guidelines ask clinicians to define the measurement more accurately and assess risk. The recommendations also emphasize treating the cause of high blood pressure including the myriad of lifestyle factors including too much sodium, too much fat, inactivity, and stress.

One major problem persisting through all previous guidelines is that our culture does not reward lifestyle changes, nor do we stress the importance. There have been numerous guidelines and yet the problem, hypertension, continues to escalate. Clinician and patient education does not seem to be making a large enough impact. We must find a way to promote a reward system for the clinicians and patients who address cause.

Unfortunately, the economics and culture of modern medicine has evolved into, “let’s treat the symptoms and give a medication.” This is not a solution for this chronic symptom, the number one risk factor for death in the world.

The guideline is well written and researched. It does a great job on emphasizing the problem, stressing the importance of correct measurement, and identifying the pressure at an earlier stage, and intervening before the prolonged exposure causes damage. It stresses the importance of lifestyle changes and the need for pharmaceutical intervention for those at increased risk.

For a clinician who focuses on the “how to implement” and “practical steps” to aid in lifestyle intervention, the guidelines were a first step. Acknowledgement that lifestyle changes and earlier intervention is the key is an important first step. I am not sure this point was emphasized enough.

If the guidelines serve as an impetus to change the economic reward system, we may not continue to read about yet another guideline in the health media.

James L. Marcum MD FACC ACLM
Speaker/Director Heartwise Ministries
Chattanooga Heart Institute