Scientific Sessions generated a great deal of buzz in the traditional and social media spheres, particularly with regards to the new ACC/AHA High Blood Pressure Guidelines. The lay media was quick to note that nearly half of the US population will now be considered hypertensive, and some doctors expressed concern that some patients may incur undue harm from over-zealous anti-hypertensive therapy.
It is important first to note that the guidelines do not require or recommend that individuals with blood pressure values falling in the “Elevated Blood Pressure” or “Stage I Hypertension” categories be reflexively treated with anti-hypertensive medication. There is room for consideration of overall-risk and prior cardiovascular events. There is an explicit role for non-pharmacological therapy. Some have noted that that while the number of individuals now considered “hypertensive” will increase, the number requiring pharmacological treatment will not increase as dramatically.
That said, why should neurologists pay attention? First, the previously-used term “pre-hypertensive” is decidedly not alarming. The updated guidelines’ use of “elevated blood pressure” is clear and unambiguous; patients and their physicians will be prompted to action earlier. Given that hypertension is a leading risk factor for stroke, we will hopefully see stroke rates decrease with time. Second, neurologists should pay attention because some patients may see us more frequently than their primary care physicians. We should be aware of these guidelines so that we are prepared to appropriately counsel and/or refer patients with elevated blood pressure. A check-in for a migraine or epilepsy medication refill may yield an opportunity to reduce long-term cardiovascular risk!
I look forward to seeing the public health gains materialize from dissemination and implementation of these guidelines.
Neal S. Parikh, MD, earned his MD from Weill Cornell Medical College and completed residency training in neurology at the same institution. He is now an NIH T32 neuro-epidemiology and vascular neurology fellow at New York-Presbyterian Hospital/Columbia University Medical Center. He tweets @ NealSParikhMD and contributes to Blogging Stroke as a blogger.