In wake of new BP guidelines, cardiologists ask: Is anyone still healthy?

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 - Franz H. Messerli, MD
Franz H. Messerli, MD (Source: Journal of the American College of Cardiology)

A pair of cardiologists expressed concern with the updated blood pressure guidelines released by the American College of Cardiology and American Heart Association in November.

In response to the low end of hypertension dropping from 140/90 millimeters of mercury to 130/90 mm Hg, Franz H. Messerli, MD, and Sripal Bangalore, MD, MHA, published an editorial titled, “Lowering the Thresholds of Diseases: Is Anyone Still Healthy?”

“Lowering the threshold of markers that indicate ‘disease’ has become a fashionable trend in contemporary cardiovascular medicine,” they wrote in the Journal of the American College of Cardiology. “The intent is to identify diseases at the earliest stage possible, so treatment can be initiated before harm has been done. … However, such reclassification can be considered like replacing the fishing rod by a fishing trawler, thereby capturing many more innocent subjects than it should.”

In an analysis of the potential U.S. population impact of the new guidelines, Paul Muntner, PhD, and colleagues noted that while the proportion of Americans diagnosed with hypertension is expected to grow from 31.9 percent to 45.6 percent, most of the individuals between 130/mm Hg and 140/90 mm Hg will be prescribed lifestyle modifications rather than medications. In all, the analysis projected just 4.2 million of the 31 million newly hypertensive Americans will be recommended for medication.

But Messerli and Bangalore weren’t reassured, writing “adherence to so-called nonpharmacological intervention or lifestyle modifications is notoriously poor in most patients in general and in the elderly specifically.”

In addition, the editorialists said simply telling a patient she is hypertensive could lead to issues, even if the patient barely meets the new criteria for high blood pressure.

“Labeling a healthy person with a disease comes at a cost,” Messerli and Bangalore wrote. “The act of labeling someone as hypertensive not only triggers absenteeism (an increase by as much as 80 percent in the year after labeling), neuroticism, anxiety, and perception of poor health, but also may cause a subsequent increase in BP, most probably mediated by increased sympathetic activity. Thus, becoming aware that one has hypertension may beget more hypertension.”

The authors closed by urging physicians to treat their patients—“not mm Hg only.”