From 2014, fewer over-60s in the US will start antihypertensive drug treatment to lower blood pressure (BP).

Instead, they should be encouraged to adopt a healthier lifestyle, according to new practice guidelines. In a surprise move, the Eighth Joint National Committee (JNC) has raised the blood pressure readings at which drug treatment should begin. Up
to now, it has applied to anyone over the age of 60 with a BP reading of 140/90, but the JNC’s 2014 Hypertension Gudielines have raised that to 150/90.

There is no evidence that the over-60s are any better off by starting medication at the lower reading, says lead author Dr Paul James, and they also have to contend with the side effects of the drugs. Doctors should instead be encouraging patients to eat a better diet, exercise every day and lose weight.

This unexpected move presents a dilemma for the UK’s ‘best practice’ group, Nice, which is currently recommending the US’s previous BP reading of 140/90 at which to begin medication.

(Source: JAMA, 2013; December 18: doi: 10.1001/jama.2013.284427)