January 30, 2013

What My Doctor Would Label Borderline or Actual Hypertension May Be Just What I Need

I've been talking for the past week about the need to break away from the "one-size-fits-all-medicine" that's practiced these day in favor of more individualized treatment -- http://bit.ly/WstYeM.  An example is my blood pressure readings.

I check my blood pressure at home once or twice a day. The readings vary greatly, but most are in the range of 130/75 to 145/90. My internist who practices standardized medicine would see this as cause concern. But a growing number of medical authorities would say the numbers are just fine, using the more individualized guidelines under which higher numbers are acceptable, and even desirable, for the elderly.

Blood Pressure Guidelines: One Size Fits All
The standardized medical advice on blood  pressure is as follows:
  • Normal blood  pressure is 120/80 (The first number is your systolic pressure; the second is your diastolic pressure.
  • You have hypertension (high blood pressure) when your average systolic number is 140 or higher and/or your average diastolic number is 90 or higher.
  • If your systolic number falls between 120 and 140 and/or your diastolic number is between 80 and 90, you have  pre-hypertension, which puts you at an elevated for eventually developing full-blown hypertension.
Blood Pressure Guidelines: Different Strokes for Different Folks
Finally medical authorities are beginning to realize that the standardized medical care treatments aren't appropriate for older people. A panel convened by the American College of Cardiology (ACC) and the American Heart Association (AHA)  recommended the following measurements for "older people"
  • Age 65 to 75: 140/90 or less
  • Age 80 and older: 140/90 to 145/90
For younger people, the standard guideline is appropriate. Reducing high blood pressure is a priority.  Untreated in significantly increases the risk of strokes and heart attacks.

But over the past 25 years, a substantial number of population-based studies have reported the same findings: in those older than 85 years (or older than 80 years in some studies), high BP is an excellent 
prognosticator of good health, while lower numbers could mean trouble ahead. These findings were summarized in an article and accompanying editorial last summer in Jama Internal Medicine.

Even here, further exploration of individualized or personalized medicine is called for. In an article in the New York Times, Dr. Ken Covinsky, a geriatrician at the University of California / San Francisco, said he'd probably recommend treatment for an 80-year-old tennis player with high blood pressure, but would be less worried about a frail 80-year-old with a systolic reading of 160, especially if she were already prone to falling. Hypertension drugs can cause falls and dizziness.

So, it's not just a matter of simply taking your age and plugging it into blood pressure guidelines, summarized above, for older people. Your physiology, your functional status, and your frailty play a part.

Personalized medicine is not as simple and easy as one-size-fits-all medicine.

For me, I've been cutting my prescribed blood pressure medication in half for months now and taking one-half a pill each day, and most of my readings were fairly close to the 120/80 standard recommendations. But now, I take a half pill every other day and the readings are clustered around the 140/90 to 145/90 range recommended for those over 80.

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