![]() Blood pressure below 120 mmHg should not be the target for any patient since the risk of harm outweighs the potential benefits. Systolic blood pressure targets are now 120–129 mmHg for patients under 65 years of age, and 130–139 mmHg for patients over 65 years of age, taking into account treatment tolerability, independence, frailty, and comorbidities. ![]() People already taking medication should not have it withdrawn at 80 years of age if it is well tolerated.īlood pressure targets for patients of all ages are lower than in previous guidelines. For people over 80 years who have not yet received blood pressure treatment, therapy should be started if systolic blood pressure is 160 mmHg or above. It is increasingly recognised that frailty, independence and biological, rather than chronological, age determine the tolerability and likely benefit of blood pressure lowering medications. The guidelines state that “treatment should never be denied or withdrawn on the basis of age”. The evidence suggests that treatment would reduce your risk of stroke and heart disease.” See your doctor if you are 65 to 80 years old and your blood pressure is above 140/90 mmHg. Professor Williams said: “Many more millions of people, particularly in the older age groups, should be receiving treatment for high blood pressure. These are patients with low to moderate risk grade I hypertension (140–159/90–99 mmHg), including 65–80 year-olds, and those with high normal blood pressure (130–139/85–89 mmHg). Treatment thresholds in the 2018 Guidelines are less conservative, with drugs recommended for patients who would previously have received lifestyle advice only. See your doctor if you have any of these symptoms. However, people with very high blood pressure may have headaches, blurred or double vision, regular nosebleeds, difficulty breathing, chest pain, irregular heartbeat, blood in the urine, confusion, or pounding in the chest, neck, or ears. High blood pressure does not usually cause symptoms. High blood pressure is also a major risk factor for heart failure, atrial fibrillation, chronic kidney disease, peripheral artery disease, and cognitive decline. High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015, of which 4.9 million were due to ischaemic heart disease and 3.5 million were due to stroke. Around 30–45% of adults are affected, rising to more than 60% of people over 60 years of age. More than one billion people have hypertension (high blood pressure) worldwide. ![]() These pills are already available and should massively improve the success of treatment, with corresponding reductions in strokes, heart disease, and early deaths.” Professor Bryan Williams, ESC Chairperson of the Guidelines Task Force, University College London, UK, said: “The vast majority of patients with high blood pressure should start treatment with two drugs as a single pill. Non-adherence increases with the number of pills, so administering the two drugs (or three if needed) in a single tablet “could transform blood pressure control rates”, state the guidelines. It is now recognised that a major reason for poor rates of blood pressure control is that patients do not take their pills. At least 80% of patients should have been upgraded to two drugs, yet most remained on one drug. ![]() This suffered from “physician inertia”, in which doctors were reluctant to change the initial strategy despite its lack of success. The previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed. The guidelines recommend starting most patients on two blood pressure lowering drugs, not one. Munich, Germany – : A single pill with two drugs could transform blood pressure treatment, according to the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines on arterial hypertension published online today in European Heart Journal (1), and on the ESC website.
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