Three leading groups of heart experts have issued updated guidelines that set blood pressure goals for people with heart disease.
Specifically, the guidelines reinforce a target blood pressure of less than 140/90 mm Hg for those at risk for heart attack and stroke.
The guidelines also set a goal of 130/80 mm Hg for those with heart disease who have already had a heart attack, stroke or a ministroke, or who have had a narrowing of their leg arteries or an abdominal aortic aneurysm.
However, the new guidelines are intended to be more flexible than ones crafted in 2007, said Dr. Clive Rosendorff, chairman of the committee that wrote the updated guidelines. Ultimately, the blood pressure goal any individual patient tries to achieve should be left to the discretion of the doctor and the patient.
For example, the lower goal may not be appropriate for older, frail patients who might experience dizziness if their blood pressure drops too much.
"Guidelines are simply that, guidelines, they are not inflexible rules," Rosendorff said.
The updated guidelines, from the American Heart Association, the American College of Cardiology and the American Society of Hypertension, were published March 31 in the journal Hypertension.
"In patients with heart disease, untreated high blood pressure is a major risk for heart attack and stroke," said Rosendorff, who is also a professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York City.
Rosendorff said these guidelines are for patients with heart disease. New blood pressure guidelines for people who have high blood pressure but do not have heart disease are in the works, but those won't be released for some time, he said.
High blood pressure has become a growing problem in the United States during the past decade, according to a recent report from the U.S. Centers for Disease Control and Prevention.
The overall death rate from high blood pressure has increased 23 percent since 2000, even as the death rate from all other causes has dropped 21 percent. That spike was seen in both genders and was most marked among those aged 45 to 64 and those over 85.
According to Rosendorff, one change in the updated guidelines is a concise statement about which drugs should be used to lower blood pressure in patients with heart disease.
"There are three drugs which have been shown to improve outcomes," he said. These include beta-blockers that slow the heart rate and reduce the force of cardiac contraction and also increase blood flow to the heart, Rosendorff said.
The guidelines also recommend angiotensin II receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACE inhibitors), which increase the size of blood vessels, thus lowering blood pressure, and diuretics that lower blood pressure by reducing the amount of fluid in the body.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said men and women with high blood pressure and heart disease may benefit from more cohesive management strategies that target both conditions.
"As large numbers of men and women have not achieved optimal control of their blood pressure and are having major cardiovascular events which could have been prevented, more needs to be done to ensure implementation of these recommendations into routine clinical practice," Fonarow said.
Dr. Harlan Krumholz, a professor of cardiology at the Yale School of Medicine, views the updated guidelines as part of an ongoing debate among experts as to what blood pressure goals should be.
"The main issue is that not many contemporary trials have focused on patients with high blood pressure in this range, and there is some uncertainty about who benefits most from drug treatment, whether adding additional pills is helpful, and in what sequence. As always, the best path for people with minor elevations of blood pressure is to treat it with lifestyle change, including diet and exercise," he said.