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NHLBI Issues New High Blood Pressure Guidelines

Guest Rose Marie

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Guest Rose Marie

I noticed a blurb on the Endocrine Society's webpage today, and thought I'd look more into this. It seems that the guidelines have been significantly modified. Since many of us cushing's patients are prediabetic and/or diabetic, we need to take note of the new guidlines:


News Release - http://www.nhlbi.nih.gov/new/press/03-05-14.htm


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.?

The guidelines can be seen here:




Stay Healthy!



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