With two-thirds of Americans over 60 experiencing high blood pressure, new treatment guidelines released on Wednesday might mean fewer medications, lower doses or even none at all for millions of people.
But the committee that released the guidelines did not have data to answer one fundamental question: How many people are affected by the change?
On Thursday, Dr. Paul Munter, a professor of epidemiology at the University of Alabama at Birmingham, came up with an answer: 7.4 million Americans out of the 51 million over 60 are in the newly defined safe range, which is blood pressure of between 140/90 and 149/90.
The old guidelines urge treatment if the systolic blood pressure — the top number — is 140 or higher. The new guidelines state that the goal for people over 60 is a systolic pressure of less than 150. In both cases the recommended diastolic pressure — the bottom number — should be lower than 90.
Dr. Munter's figure was derived in response to an inquiry on Wednesday from a reporter. It was based on his analysis of data from the National Health and Nutrition Survey, a federal study that combines interviews and health exams to gather information on the health of Americans.
More than half of those 7.4 million people — 4.2 million — are currently taking medications to lower their blood pressure, yet still remain over 140/90. Under the old guidelines, that often led to more treatment, with doctors urging additional medications or higher doses to bring systolic pressure down. Under the new guidelines, that is no longer recommended.
The other 3.2 million can continue without treatment, though in the past they were often warned that no treatment would put them at risk of a stroke or heart attack. The committee said that anyone over 60 with pressure below 140/90 after treatment can stay on the medications, as long as there are no side effects.
Many doctors take issue with the new targets, saying a systolic pressure goal of 150 is too high. They say that the committee, composed of 17 academics, was too narrowly focused on data from randomized trials and that it should have considered other forms of evidence.
But the committee said it was convinced by rigorous studies that failed to find an advantage for people over 60 having pressure lower than 150.
A lower pressure, without medications, is certainly healthier, the group said. But achieving a lower pressure by using medications is not the same as having it naturally, it said, as medications can have side effects.
"When you are taking an asymptomatic person and putting them on medication, you want to be sure you are doing good," said Dr. Paul A. James, the chairman of the department of family medicine at the University of Iowa and co-chairman of the guidelines committee.
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