If you’re unsure what your blood pressure levels should be, new advice from the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) may help.
For many doctors and consumers, uncertainty arose after the 2015 release of results from a large clinical trial called SPRINT. Those researchers advised that people with high blood pressure aim for a systolic (upper number) of less than 120 mm/Hg. That’s well below what’s recommended by many expert groups and the government.
But SPRINT included only people at high risk for cardiovascular disease, so its findings — and its researchers’ advice on blood pressure levels — didn’t necessarily apply to those at lower risk. And getting blood pressure below 120 (as the SPRINT researchers suggested) usually requires a high dose of medication or the use of multiple medications. Both significantly increase the likelihood of serious side effects, such as fainting from severely low blood pressure or kidney failure.
Enter the new advice from ACP and AAFP. If you are 60 or older and have no other cardiovascular risk factors (diabetes, high cholesterol, a smoking habit), these guidelines recommend maintaining a systolic reading below 150 mm/Hg.
That’s appropriate for most people in the above group, researchers say. Here’s why: The two dozen studies reviewed for the guidelines suggested that aggressive treatment to get systolic blood pressure below 140 in people older than 60 didn’t extend life or reduce the number of heart attacks. It did, however, possibly lower the risk of strokes.
The new guidelines also recommend that people older than 60 who are at high risk for cardiovascular problems or who previously suffered a heart attack or stroke consider treatment with medication when their systolic level reaches 140. The goal for these people is a systolic level below 140.
However, the new guidelines leave it up to people and their doctors to determine exactly what blood pressure level works best for them. That’s because some people may be able to better tolerate the side effects that can occur with aggressive medication therapy to lower blood pressure.
If you are younger than 60, the ACP/AAFP guidelines do not include recommendations for you. You can follow these 2014 guidelines from the expert group known as the Eighth Joint National Committee and the thinking of medical experts from Consumer Reports and Consumer Reports Best Buy Drugs: You’re considered to have high blood pressure if your systolic reaches 140 or your diastolic — the bottom number — reaches 90 or above. (Consumer Reports’ medical consultants also suggest a goal of 140/90 for adults of any age who have diabetes and for those younger than 50 with chronic kidney disease.)
Reaching these numbers calls for lifestyle changes such as sodium restriction, weight loss and exercise, and if those methods are ineffective, medication to lower blood pressure.
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