A Closer Look at the New Blood Pressure Guidelines
Posted: Thu Feb 01, 2018 8:43 am
In November 2017, the the ACC/AHA came out with new guidelines for blood pressure.
You can read the full guidelines here in a downloadable PDF ...
http://www.onlinejacc.org/content/early ... 017.11.005
And a summary of the new guidelines here...
http://www.acc.org/latest-in-cardiology ... e-aha-2017
And here is a chart comparing the old guidelines (JNC 7) vs the new (2017 ACC/AHA)...
First, the bad news...
From my colleague, Don Forrester, MD...
"As with previous guidelines the first recommended approach is lifestyle modifications.
This was present in the last recommendations as well but for higher "numbers".
They were ignored by most organizations and prescribers that I am aware of.
If the medical industry responds like it did to the previous guidelines I predict:
• more Americans will be labeled with a "disease"
• more Americans will be prescribed anti hypertensive drugs
• An increase in the number of strokes and heart attacks due to over-treatment due to the "J" point phenomenon
• higher costs
• more morbidity and mortality with associated disability and suffering"
Now, the good news...
Diet and lifestyle is still the official recommended first line of treatment.
Let me repeat that, Diet and lifestyle is still the official recommended first line of treatment.
We always knew that those with “pre hypertension” were an issue as they were in a gray zone where the benefit of medication did not outweigh the risk and may have been leading to increased deaths. Dr Goldhamer reviews this issue nicely in the intro of his study on fasting and HTN.
https://www.scribd.com/document/3272720 ... pertension
"Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg."
Apparently, they now believe the benefits of treatment outweighs the risk for this group. If the treatment is diet and lifestyle, we all win. Sadly, it probably won't be.
Coincidently, there was a presentation 2 days ago at the AHA meeting on the DASH diet. While not as healthy a diet as the diet we recommend, it clearly showed that...
a) eating healthier lowers BP even in those with a higher salt intake,
b) lowering sodium alone lowers BP
c) eating healthier and lowering sodium lowers BP the most.
Journal of the American College of Cardiology; Nov. 12, 2017, presentation, American Heart Association's annual meeting, Anaheim, Calif. http://www.acc.org/latest-in-cardiology ... t-aha-2017
Maybe this will be published but there are already several older papers on the same diet showing the same results.
(UPDATE: The study is now published)
Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure
Journal of the American College of Cardiology
Volume 70, Issue 23, 12 December 2017, Pages 2841-2848
https://doi.org/10.1016/j.jacc.2017.10.011
Also...
The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-Sodium)
JADA August 1999 Volume 99, Issue 8, Supplement, Pages S96–S104
http://jandonline.org/article/S0002-8223(99)00423-X/pdf
viewtopic.php?f=22&t=57369&p=579589#p579589
The answer remains, follow a diet based predominately on minimally processed plant foods, low in fat, sat fat and calorie density and with low/no added SOS.
In Health
Jeff
You can read the full guidelines here in a downloadable PDF ...
http://www.onlinejacc.org/content/early ... 017.11.005
And a summary of the new guidelines here...
http://www.acc.org/latest-in-cardiology ... e-aha-2017
And here is a chart comparing the old guidelines (JNC 7) vs the new (2017 ACC/AHA)...
First, the bad news...
From my colleague, Don Forrester, MD...
"As with previous guidelines the first recommended approach is lifestyle modifications.
This was present in the last recommendations as well but for higher "numbers".
They were ignored by most organizations and prescribers that I am aware of.
If the medical industry responds like it did to the previous guidelines I predict:
• more Americans will be labeled with a "disease"
• more Americans will be prescribed anti hypertensive drugs
• An increase in the number of strokes and heart attacks due to over-treatment due to the "J" point phenomenon
• higher costs
• more morbidity and mortality with associated disability and suffering"
Now, the good news...
Diet and lifestyle is still the official recommended first line of treatment.
Let me repeat that, Diet and lifestyle is still the official recommended first line of treatment.
We always knew that those with “pre hypertension” were an issue as they were in a gray zone where the benefit of medication did not outweigh the risk and may have been leading to increased deaths. Dr Goldhamer reviews this issue nicely in the intro of his study on fasting and HTN.
https://www.scribd.com/document/3272720 ... pertension
"Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg."
Apparently, they now believe the benefits of treatment outweighs the risk for this group. If the treatment is diet and lifestyle, we all win. Sadly, it probably won't be.
Coincidently, there was a presentation 2 days ago at the AHA meeting on the DASH diet. While not as healthy a diet as the diet we recommend, it clearly showed that...
a) eating healthier lowers BP even in those with a higher salt intake,
b) lowering sodium alone lowers BP
c) eating healthier and lowering sodium lowers BP the most.
Journal of the American College of Cardiology; Nov. 12, 2017, presentation, American Heart Association's annual meeting, Anaheim, Calif. http://www.acc.org/latest-in-cardiology ... t-aha-2017
Maybe this will be published but there are already several older papers on the same diet showing the same results.
(UPDATE: The study is now published)
Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure
Journal of the American College of Cardiology
Volume 70, Issue 23, 12 December 2017, Pages 2841-2848
https://doi.org/10.1016/j.jacc.2017.10.011
Also...
The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-Sodium)
JADA August 1999 Volume 99, Issue 8, Supplement, Pages S96–S104
http://jandonline.org/article/S0002-8223(99)00423-X/pdf
viewtopic.php?f=22&t=57369&p=579589#p579589
The answer remains, follow a diet based predominately on minimally processed plant foods, low in fat, sat fat and calorie density and with low/no added SOS.
In Health
Jeff