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JAMA Patient Page
February 5, 2014

New Guideline for Treatment of High Blood Pressure in Adults

JAMA. 2014;311(5):538. doi:10.1001/jama.2013.286206

High blood pressure, or hypertension, is one of the most common conditions in adults seen in primary care clinics.

There are 2 numbers in a blood pressure measurement: systolic blood pressure (the top number) and diastolic blood pressure (the bottom number). High blood pressure occurs when either of these numbers is too high, which can occur without causing symptoms. High blood pressure can lead to heart attacks, strokes, and kidney failure. Treatment of high blood pressure prevents these complications and is important even when no noticeable symptoms are present.

Guidelines are instructions that help doctors decide the best treatments for patients. A new guideline for treatment of high blood pressure based on the latest research appears in the February 5, 2014, issue of JAMA. The guideline addresses when to use drugs to treat high blood pressure and which drugs to use, but it also emphasizes that people with high blood pressure should follow a healthy lifestyle (low-salt diet and exercise) along with taking medication. The major medication recommendations include

  1. For adults aged 60 years or older, medication should be started when systolic blood pressure is 150 mm Hg or higher or diastolic blood pressure is 90 mm Hg or higher.

  2. For adults younger than 60 years, medication should be started when systolic blood pressure is 140 mm Hg or higher or diastolic blood pressure is 90 mm Hg or higher.

  3. For adults with chronic kidney disease or diabetes, no matter what age, blood pressure medication should be started when systolic blood pressure is 140 mm Hg or higher or diastolic blood pressure is 90 mm Hg or higher.

  4. If the blood pressure goal is not reached within 1 month of starting medication, the dose of the medication should be increased or additional medication should be added.

The guideline also recommends types of blood pressure medication that are best for different people and emphasizes that treatment decisions must take into account the circumstances of each individual.

Recommendations 1 and 3 above represent changes from common practice. Previously, drug treatment was recommended for people older than 60 years at a systolic blood pressure of 140 mm Hg or higher, and treatment for people with chronic kidney disease or diabetes was recommended at blood pressures higher than 130/80 mm Hg.

Contact your primary care doctor if you have questions or concerns about your blood pressure.

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For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish. For a general discussion of blood pressure and how it is measured, see the JAMA Patient Page on hypertension published in the June 25, 2008, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Source: National Heart, Lung, and Blood Institute

Correction: This article was corrected online February 7, 2014, for a factual error.

Topic: Cardiovascular Disease