Guidelines seek to deflate high blood pressure

The National Heart, Lung and Blood Institute issued updated guidelines for the treatment of high blood pressure.

The guidelines, known as the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, are the first issued by the institute since 1992.

The most notable difference from previous guidelines is the stratification of hypertension patients into risk groups in order to guide treatment decisions. The risk groups are decided by the presence of risk factors, such as high blood cholesterol and related organ damage.

For patients with uncomplicated hypertension, the guidelines recommend diuretics and beta blockers as the first line of treatment. Patients with complicated hypertension, on the other hand, should use other medicines as monotherapy or in combination with diuretics or beta blockers.

Older people with isolated systolic hypertension, if necessary, should be treated first with diuretics, the guidelines advise. Patients with diabetes, kidney damage and high blood pressure should begin treatment with ACE inhibitors. Patients who had a heart attack may warrant beta-blocker therapy and those with heart failure should try ACE inhibitors and diuretics before turning to other therapies.

The guidelines also recommend that patients take initial medicines in low doses; that long-acting formulas are preferable and that diuretics can enhance the effects of other medications. And finally, they reiterate earlier warnings about negative effects of short-acting nifedipine, a short-acting calcium channel blocker. If this product is used at all, it should be used with great caution.

Regardless of risk group, the guidelines recommend that all patients on drug therapy make lifestyle changes, including a healthy diet rich in fruits, vegetables and low-fat dairy; limited intake of alcohol, sodium and dietary saturated fat; and increased physical activity. PR