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Enforcing New Blood Pressure Guidelines May Lead to Serious Falls

(p. A23) "Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure." This is the type of headline that raises my blood pressure to dangerously high levels.

. . .

The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine.

. . .

A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated -- making their blood pressures too low.

. . .

Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.

. . .

I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry's middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary -- and that usually means more medications.

So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren't easily measured by numbers, yet are more important to health -- real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.

For the full commentary, see:

H. GILBERT WELCH. "Rethinking Blood Pressure Advice." The New York Times (Thurs., NOV. 16, 2017): A23.

(Note: ellipses added.)

(Note: the online version of the commentary has the date NOV. 15, 2017, and has the title "Don't Let New Blood Pressure Guidelines Raise Yours.")

Welch has a book that makes a similar point, though more broadly, to that made in the passages quoted above:

Welch, H. Gilbert. Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care. Boston, MA: Beacon Press, 2015.

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