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Redefined blood pressure guidelines provoke dispute

The Philadelphia Inquirer/MCT--Another medical guideline, another controversy.

This time, a group of experts wants to redefine high blood pressure — it's now OK for some of us to be a little higher, they say — and other doctors are resisting the change.

Raymond Townsend, a kidney specialist at the University of Pennsylvania who helped write the new guidelines, said the group's work is based on the best available evidence from high-quality clinical trials. Published last week in the Journal of the American Medical Association, the recommendations allow people over 60 and those with diabetes and kidney disease to have slightly higher blood pressure than current standards, a change that could mean having to take fewer pills.

“It certainly created a little bit of stir,” he said, referring to immediate criticism from the American Heart Association, which supports the old rules.

“If you want to practice medicine in an evidence-based era, we looked at the evidence.”

Mariell Jessup, another Penn doctor who is president of the American Heart Association, said she worries about public reaction. “I just get anxious when people hear that they don't need as much medicine and they can allow their blood pressure to drift up,” said Jessup, medical director of the Penn Heart and Vascular Center.

According to the Journal of the American Medical Association, or JAMA, nearly 78 million adults in the United States had high blood pressure in 2010; only about half controlled it adequately. High blood pressure is a risk factor for heart disease, stroke, and kidney disease.

“One in three people in this country has hypertension, and it's a silent killer,” Jessup said, “and I don't think this is the time, when we have rising levels of diabetes and obesity, to be less vigilant about blood pressure.”

Last month, Jessup was in Townsend's position, defending controversial new guidelines from the heart association and the American College of Cardiology calling for more people to take statins, a type of cholesterol-lowering drug, to prevent heart disease, heart attacks or stroke. Those guidelines also eliminated specific numeric targets for LDL, or bad cholesterol. The two organizations plan to develop their own blood pressure standards, Jessup said.

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