A panel of experts appointed by the Heart, Lung and Blood Institute has issued new evidence-based guidelines for the treatment of hypertension (high blood pressure). Consistent with the previous guidelines published in 2003, the goal of treatment for most people should be to achieve blood pressures of 140/90 mmHg or less. The only significant change is that for people over 60 years of age, treatment need only achieve a blood pressure of 150/90, rather than 140/90. The new guideline reflects the fact that there is no clear evidence that lowering systolic blood pressure in older persons to 140 achieves any additional benefit over lowering it to just 150.

The new guidelines make a lot of sense. With age, arteries get stiffer and less elastic. Systolic pressure (the peak pressure in the arteries as a result of the ejection of blood from the heart after a heartbeat) would be expected to be higher in stiff arteries than it would be in more elastic arteries. So a slight increase in systolic pressure is just a normal consequence of the aging process.

The new guidelines are just that; guidelines, based on the best available evidence. The panel fully expects that the recommendations will be discussed and debated by physicians. It will be interesting to see whether the American Heart Association eventually adopts the new guidelines; currently it still recommends that blood pressures be lowered to 140/90 in all hypertensive patients.

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