Redefining High Blood Pressure is a Two-Edged Sword

Two months ago I highlighted the new American Heart Association guidelines for defining high blood pressure. I was a bit skeptical, as you may have noticed (see this blog Nov. 14, 2017).

A recent opinion piece by Aaron Carroll, a professor of pediatrics at Indiana University School of Medicine, does a better job than I of pointing out that while keeping blood pressure under control is important, the new guidelines could easily lead to over-treatment of patients who might not actually need treatment. That's because the new guidelines are based on a study of people who were at high risk of cardiovascular disease, either by virtue of their age or because they had another underlying cardiovascular or kidney condition. So technically, the new guidelines may not apply to people whose only symptom is high blood pressure. But will patients and their doctors be aware of that? In addition, some people whose blood pressures are usually normal have slightly elevated blood pressures when they are under the stress of being in a doctor's office - its called "white-coat hypertension".

Thank you, professor Carroll, for your thoughts on this issue.