A Guideline Gusher Coming–And Headed Down?

From the annual scientific sessions of the American College of Cardiology

Sometime next year, Americans should have a quartet of new, government-sponsored guidelines to shape their health care.

Slated to be released in 2010 from the National Heart, Lung and Blood Institute are updated guidelines for treating hypertension (the eighth edition of the JNC guidelines), hyperlipidemia (the fourth version of the ATP guidelines), and obesity, and a “totally new” fourth document that will “mold all these guidelines into an integrated whole to hopefully get better implementation by U.S. primary care physicians,” said Dr. Raymond J.  Gibbons, a cardiologist at the Mayo Clinic in Rochester, Minn. and a member of the committee working on the integrated, überguideline.

image courtesy of Flickr user stephanebenito

image courtesy of Flickr user stephanebenito

A report at this year’s ACC meeting raised the issue of whether the new guidelines should drop the blood pressure and lipid levels that separate normal from disordered and needing treatment. This question is under review by the guideline-writing committees, but for now their direction remains confidential, said some committee members.

Presenting his polypill concept and the results from the pill’s initial clinical test at the ACC meeting, Dr. Salim Yusuf from McMaster University in Hamilton, Ontario, noted that current standards of normal blood pressure and lipids are too high. Levels in young children worldwide and in adults in rural areas of developing countries suggest that serum levels of low-desnity lipoprotein cholesterol should be below 100 mg/dL, systolic blood pressure could idealy be close to 100 mm Hg, and that a body mass index of about 20 kg/m2 would lead to substantially fewer cases of type 2 diabetes, he said. The polypill is designed to modestly lower blood pressure and cholesterol in many people older than 50, including those whose levels aren’t abnormal by today’s standards.

“We know from observational data that a blood pressure of 120 mm Hg is better than 140 mm Hg, but we don’t know that using drugs to lower pressure below 140 mm Hg is useful except in patients with diabetes or chronic kidney disease,” said Dr. Daniel W. Jones, a hypertension specialist at the University of Mississippi in Jackson and a member of the hypertension-guidelines committee. “Some say we should use pills to lower blood pressures to what observational evidence says is ideal. The more conservative approach is to only use lifestyle to do that.”

—Mitchel Zoler @mitchelzoler

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Filed under Cardiovascular Medicine, Endocrinology, Diabetes, and Metabolism, Family Medicine, Internal Medicine, Practice Trends

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