Landmark changes to blood pressure guidelines that diagnosed 31 million more Americans with hypertension may cause more harm than good, according to a new report.
In November the American Heart Association made controversial recommendations to lower diagnosis and treatment thresholds for people with high blood pressure, which is often referred to as the ‘silent killer’ because it quietly damaging arteries and organs until it leads to a stroke or a heart attack.
However, an Australian study published Monday found that 80 percent of Americans newly diagnosed will not see any benefit from lowering their blood pressure.
In fact, the diagnosis was linked to an increased risk of anxiety and depression, experiencing negative side effects from blood pressure-lowering drugs and difficulty getting insurance coverage because of the pre-existing condition.
A study researchers in Australia published Monday found that 80 percent of people diagnosed with high blood pressure under new guidelines should not have been (stock image)
A 2017 report by the American Heart Association and American College of Cardiology made a controversial recommendation to lower the threshold for what constitutes high blood pressure from 140/80 mmHg to 130/80 mmHg.
It also recommended lowering the threshold for drug treatment in adults who are at high risk for cardiovascular disease (CVD).
The new guidelines will result in 14 percent more US adults diagnosed as having hypertension and two percent more recommended for immediate drug treatment.
The report claimed that changes would ‘ensure that guideline recommendations remain current’.
Researchers from University of Sydney and Bond University assessed the benefits and harms of the new guidelines in a study published Monday.
‘The ACC/AHA guideline follow an established pattern in the medical specialties, where disease definitions are more often widened than narrowed,’ the report said.
Could a smartphone app improve blood pressure management?
Several smartphone apps have claimed to be effective in helping people manage high blood pressure by providing reminders to take medication.
However, study from University of Toronto revealed that while people who used a smartphone app had a small improvement in self-reported medication adherence, there was no detected change in systolic blood pressure.
Failing to adhere to medication guidelines has been known to be a key problem among people with high blood pressure.
The study published Monday examined 411 participants with poorly controlled high blood pressure.
Half of the participants were instructed to download an app called Medisafe, which includes reminder alerts, adherence reports and optional peer support.
The other half made up a control group that did not receive any intervention.
Across a span of 12 weeks participants self-reported their medication use.
The findings revealed that while those in the Medisafe group were more likely to take their medication as instructed, they did not show significant improvements in blood pressure compared with the control group.
The authors concluded that while smartphone apps didn’t have any harmful effects, they were not as useful as marketing may indicate.
‘Such widened definitions usually label people as unwell, even if they are at low risk of a disease, and thus have the potential to cause harm.’
The findings revealed that 80 percent of the 31 million Americans diagnosed with hypertension under the new guidelines have a less than 10 percent risk of developing cardiovascular disease and would likely not be able to reduce their risk by lowering blood pressure.
The diagnosis may also be linked to an increased risk of anxiety and depression.
Only nine percent of the newly diagnosed could benefit from the changes and for the remaining 11 percent ‘the benefits and harms may often be in rough balance’, the authors said.
Many of the 4.2 million people who will be recommended for immediate treatment are at low risk for CVD despite meeting the threshold under the new guidelines.
Blood pressure-lowering medications have been known to cause a variety of negative side effects including hypotension, syncope, electrolyte abnormalities, acute kidney injury, or acute renal failure.
The final point that the authors made was that in countries without universal health coverage, such as the US, those who are newly diagnosed with hypertension may face difficulties gaining insurance coverage because of the ‘pre-existing’ condition.
Overall the report concluded that lowering thresholds would cause more harm than good and should be reconsidered.
‘Doctors should continue to support healthy choices with regard to diet and physical activity regardless of whether a patient’s systolic blood pressure is above or below 130 mmHg,’ co-author Jenny Doust, a professor at Bond University, said.
‘When there is a question of starting blood pressure medication, the risk of cardiovascular disease should be estimated using a reliable risk calculator and the potential benefits and harms discussed with the patient’.