The morning of May 14 in Washington, D.C., national health officials unveiled a new “road map” for finding and treating high blood pressure, and cutting the massive, deadly toll it takes each year on America’s health.
Back in Ann Arbor, a family doctor was smiling.
Dr. Lee Green is a family physician at the U-M Health System (UMHS) who sees patients at the Briarwood Family Practice Center. He’s also a member of the elite committee that compiled and wrote the new national guidelines for elevated blood pressure and its more serious form, hypertension.
Green was the only family physician and the only Michigan doctor to serve on either the 10-member executive committee or the entire national committee. He offered his expertise as a primary care physician, as well as a clinical epidemiologist and specialist in evidence-based medicine.
“It was good to bring the family doctor’s perspective to this effort, because family practitioners take care of most of the high blood pressure patients in the U.S.,” Green says. “These guidelines give family doctors and general internists a cutting-edge tool for managing patients with elevated blood pressure and full-blown hypertension.”
The guidelines, which were published simultaneously in the Journal of the American Medical Association, are designed to help doctors across America give the best-possible care to people with high blood pressure–including those who still have a chance to stave off the condition through diet and exercise.
In a few pages and flowcharts, the guidelines give the best-available and most current knowledge about what hypertension treatments work best for patients according to their blood pressure levels and other conditions.
The new report puts strong emphasis on optimal treatment of high blood pressure with effective lifestyle changes and medications, and prevention of full-blown hypertension in people who have elevated blood pressure or “pre-hypertension.”
Blood pressure is expressed in two numbers, one on top of the other, that measure the pressure of blood traveling in blood vessels, both during and between heartbeats. The top number is the “systolic” blood pressure, and the bottom number is the “diastolic” blood pressure. Pressures are measured in millimeters of mercury, or mm Hg.
Pre-hypertensive people are identified as those whose systolic blood pressure is between 120 and 139 mm Hg, or whose diastolic blood pressure is between 80 and 89 mm Hg. Hypertension is defined as greater than 140 mm Hg systolic, or 90 mm Hg diastolic.
The new guidelines point out that in people older than 50 years, systolic blood pressure of more than 140 mm Hg is a much more important risk factor for cardiovascular disease than elevated diastolic blood pressure.
The authors also stress that a person’s risk of developing cardiovascular disease of any kind doubles each time his or her systolic blood pressure goes up 20 units or his or her diastolic pressure goes up 10 units.
The new guidelines officially are called the JNC-7 report, short for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The effort to compile and prepare the guidelines was funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health.
Green, an associate professor in the Department of Family Medicine at the Medical School, also served on the last joint national committee on this subject, which published its recommendations in 1997. But he notes that a lot has been learned since then about the best way to prevent and treat hypertension.
For example, he cites newly published findings on a class of medicines called thiazide-type diuretics, which have been around for years and are inexpensive. A recently published study showed that these drugs are just as effective in lowering blood pressure and preventing heart attacks as more costly and newer drugs, and better than other drugs in preventing stroke and heart failure.
