Measure Up Pressure Down American Medical Group Foundation

New high blood pressure guideline in summary
In December 2013, panel members appointed to the Eighth Joint National Committee (JNC-8), released a report that provided new recommendations for treatment goals and medications in the management of adults with high blood pressure. Through randomized controlled trials, evidence was drawn to support changing the treatment plan for patients aged 60 and older with high blood pressure (and without diabetes or chronic kidney disease) to achieve a blood pressure goal of 150/90 mmHg. The previous goal was 140/90 mmHg.

There has been some debate and controversy over whether or not these new guidelines will significantly impact the treatment of high blood pressure among older Americans; causing either greater harm or benefit to this population. The new guidelines place particular emphasis on avoiding harm in treating older patients too aggressively.

How does it affect you?
The patient group affected by the new recommendations is relatively small. These new guidelines affect fewer than 1 out of 20 patients. People with high blood pressure will have more flexibility, and 96% of patients will likely have no change to their current treatment plans.

Although this new guideline provides evidence-based recommendations for the management of high blood pressure and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment. Decisions about your care must be carefully evaluated with you, your doctor, and entire care team to determine the best treatment plan for you.

Guidelines will continue to evolve
New guidelines are intended to avoid challenges some patients have with treatment where goals are not clearly defined by scientific evidence. Measure Up/Pressure Down® will aim to correctly assess and prioritize an evolving landscape in the treatment of high blood pressure for patients. We want patients and their doctors to continue to focus on the key message that blood pressure control is important, especially because nearly half of all patients are not in control of their blood pressure. The campaign will continue to provide ongoing updates and resources for patients as guidelines continue to evolve over the coming months.

You may still have questions about the new guidelines, from why they were issued to how they affect your treatment plan. The Measure Up/Pressure Down® campaign answers your questions:

• How does the new guideline change the existing one? [+]
  The previous high blood pressure (hypertension) guideline, called the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), was issued a decade ago, in 2004. This new guideline was released to update it, incorporating newer evidence. Among the important changes in recommendations, the 2014 Evidence-Based Guideline addresses goal blood pressures for specific groups of people with high blood pressure, including those age 60 and older, those with diabetes, and those with chronic kidney disease. These changes affect only a small proportion of all people with high blood pressure, for whom they establish slightly higher goal blood pressures. But the new guideline continues to emphasize how important it is for everyone to keep their blood pressure at or below their goal.
• Who recommended these changes and why? [+]
  The new guideline is called the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). It was developed over the course of four years and is based on a review of the latest scientific evidence. Experts were invited to participate by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health. They were selected based on their knowledge of high blood pressure, primary care (including geriatrics), cardiology, nephrology, nursing, pharmacology, clinical trials, evidence-based medicine, epidemiology, informatics, and the development and implementation of clinical guidelines in systems of care.
• Why are different health organizations saying different things about this guideline and the new goals for blood pressure control? [+]
  It is true that guidelines issued from different organizations may not all agree in every respect. Many different organizations are interested in improving high blood pressure management—government agencies, physician groups, non-profit organizations, and patient advocacy groups. These organizations may issue their own guidelines at different times and may use slightly different criteria for reviewing the evidence. For example, the 2014 Evidence-Based Guideline used very strict criteria for which studies, published in the medical literature, were considered in developing the guidelines. Other groups might include different studies or reviews. In addition, some guidelines focus on particular groups of patients, such as African-American patients. It is important to note, however, that differences among the various guidelines are relatively small, and the differences affect only small groups of patients with specific conditions or within certain age ranges.
• Am I affected by the new treatment guideline? [+]
  People age 60 or older and those with diabetes or chronic kidney disease are potentially impacted by the new blood pressure guidelines. If you answer “yes” to either of the following questions, your recommended goal blood pressure level may now be different:

  1. Are you age 60 or older without diabetes or chronic kidney disease? If yes, the new guideline recommends a goal blood pressure of less than 150/90 mm Hg (the previous guideline was 140/90).
  2. Are you age 18 or older, have high blood pressure, and have diabetes and/or chronic kidney disease? If yes, the new guidelines recommend a goal blood pressure level of less than 140/90 mm Hg (the previous guideline was 130/80).

  If you answered “no” to both of these questions, your goal blood pressure level has not changed; it remains less than 140/90 mm Hg.
• How will treatment guidelines change my care? [+]
  For the vast majority of patients with high blood pressure, there will be no change in your treatment or medications. The new guideline recommends that patients who are stable on their current treatment do not need to make any changes. Patients who may be affected by the new goal blood pressure recommendations should review their treatment plans and goals with their physicians and care team before taking any action.
• Should I adjust my medications? [+]
  You should not adjust your medications without first talking with your physician or care team. There are many good reasons for this. For example, certain medications can only be stopped gradually. Or medications you are on may be interacting with others, and stopping one could lead to side effects from another one.
• Should I change my lifestyle activities, like eating right and being active? [+]
  Lifestyle should continue to be a key part of your high blood pressure control plan. You should continue to eat a healthy, low sodium diet, exercise regularly, and avoid alcohol. Find tips for a healthy lifestyle in our free patient booklet, Circulation Nation: Your Roadmap to Managing High Blood Pressure and tip sheets.
• If I’m over 60 but my doctor says my blood pressure is in control, do I need to change my therapy? [+]
  No. If your blood pressure is under good control and you are not having any problems with your treatment, the new guideline recommends that you do not make changes.
• I have diabetes, what should I do? [+]
  Discuss your current blood pressure goals and treatment with your physician or care team. The new guideline recommends a goal blood pressure of less than 140/90. Although this is higher than the previous recommendation, it is still very important to keep your blood pressure in control, so you may need changes to your treatment if your blood pressure not at your goal.
• I have chronic kidney disease, what should I do? [+]
  Discuss your current blood pressure goals and treatment with your physician or care team. The new guideline recommends a goal blood pressure of less than 140/90. Although this is higher than the previous recommendation, it is still very important to keep your blood pressure in control, so you may need changes to your treatment if your blood pressure not at your goal.
• Who should I talk to about other questions? [+]
  Guidelines are important, but care should always be individualized, taking into account other conditions you may have, as well as your preferences. Discuss any concerns or questions with your physician or health care team. Remember, all decisions about your care should be carefully evaluated by you, your doctor, and your care team, to determine the best treatment plan for you.

Measure Up/Pressure Down® national partners and other healthcare organizations have issued statements regarding changes to high blood pressure guidelines.

• American Heart Association [+]
  The American Heart Association (AHA) recommends that healthcare providers follow existing guidelines for treating high blood pressure (JNC-7 published in 2004). According to AHA President Mariell Jessup, MD, “We believe there’s just not enough evidence at this point to justify such a major change in how we treat people with high blood pressure.” The full AHA statement is available here.