What matters is not only how low you get it, but but how you get it low.
That is the basis for the new blood pressure guidelines that call for raising the threshold in people 60 and older for treating high blood pressure from the previous value of 140 systolic (top number) up to 150. And why the change?
Apparently, the evidence for those 60 and over for a protective effect from pressure naturally less than 150 (through lifestyle measures) was clear, but that the benefit of lowering below 150 with medication was unproven.
Or to quote from the report: “The relationship between naturally occurring BP and risk is linear down to very low [blood pressure], but the benefit of treating to these lower levels with antihypertensive drugs is not established.”
This is a hugely important lesson that is repeated often in medicine: Using a medication or treatment to achieve a certain state does not guarantee the same results as when that state occurs naturally.
One of the best examples of that rule came from the CAST trial published in 1989, a study that examined the use of drugs to control extra beats after a heart attack. It was well known that extra heart beats were linked to a poor outcome for heart attack survivors, and the theory went that controlling the extra heart beats with medicine would improve the prognosis. The drug did control the extra heart beats as expected, but it also had the disastrous outcome of increasing deaths by causing more serious problems.
To put this issue in perspective, there is no doubt that high levels of blood pressure (as described in the guideline statement) require aggressive treatment with medication. And treating high levels of blood pressure with medication is an effective way to reduce strokes, heart attacks, and death.
But to again quote from the guideline report:
“For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise can- not be overemphasized. These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”
To read more about lifestyle approaches for blood pressure: