New guidelines on how to diagnose and treat high blood pressure in the United States are already making their mark on the healthcare system.
Some estimates show nearly half of all U.S. adults will now be diagnosed with hypertension. That’s around 103 million people.
The goals set forth by the American Heart Association and the American College of Cardiology to treat hypertension are ambitious.
The guidelines, culled from a review of more than 900 studies on the disease, put a renewed focus on diet and exercise.
“The guidelines emphasize the fundamental and critical nature of physical activity and nutrition for both prevention and treatment for hypertension,” Dr. William H. Frishman, director of medicine at Westchester Medical Center and chairman of the Department of Medicine at New York Medical College of Touro College and University, told Healthline.
However, not all people with hypertension are expected to follow the recommendations.
In addition, groups such as the elderly will require medication to help bring down their readings.
Some experts say a rise in prescriptions along with increased costs are inevitable.
Dr. Khaled Dajani, a cardiologist at Loyola University Medical Center in Illinois, supports a more preventative approach toward treating hypertension.
He does expect the new guidelines to increase healthcare costs — whether it be an uptick in prescriptions or the amount of time needed by doctors to fully explain the lifestyle changes detailed in the recommendations.
“It’s going to increase the cost for treatment and the time for treatment,” he told Healthline.
The AMA and ACA didn’t include projected costs in their recommendations.
Trends show that even before the new guidelines, the costs to treat hypertension were on the rise. In 2010, direct costs totaled almost $43 billion, according to the Piper Report.
About half of that is tied to prescription drugs.
Analysts at TechNavio estimate that global hypertension drug market will reach $32 billion in 2020.
Details on new guidelines
According to the new guidelines, high blood pressure is now defined as a reading of 130/80.
That’s down from the previous baseline of 140/90.
A blood pressure reading between 120 and 129 is considered elevated.
Anything above that is hypertension.
Either scenario will require a doctor to lay out a detailed treatment plan, depending on the severity of the reading.
The treatment plan in the guidelines encourages those with hypertension to adopt the DASH diet.
Backed by the National Institutes of Health (NIH), the diet promotes consuming fruits and vegetables, lean protein, and low-fat dairy products. Reducing sodium intake is key.
You can also expect your doctor to talk about the importance of getting 150 minutes of exercise every week.
They may also encourage you to purchase a blood pressure reader to use at home on a regular basis.
At the clinic where Dajani practices, patients get this kind of information from a team of experts, which includes dietitians and exercise physiologists.
“When you come to the prevention center, the patient sees all these people,” he said. “We use a team approach.”
But that’s not the case for many people across the country, Dajani said.
Today, most patients are allotted about 20 minutes for a doctor’s appointment.
Dajani said that doesn’t allow much time for a thoughtful discussion on lifestyle changes.
“Finding the time with these new guidelines, that’s the problem,” Dajani said. “And if you go beyond that [20 minutes] then you have productivity issues.”
Doctor, patient commitment
Dr. Joaquin Cigarroa, head of cardiovascular medicine at Oregon Health & Science University, was also part of the team that worked on the guidelines.
He told Healthline that the recommendations ask a lot of both doctor and patient, but they’re necessary to avoid medication.
“Once you’ve started therapies,” he said, “you’re likely on them for the rest of your life.”
Encouraging patients to eat healthy and to lose weight is proven to bring down blood pressure, he noted.
“Five to ten pounds can make a difference,” he said.
Even if more patients end up on prescribed medication, Cigarroa doesn’t see the new guidelines causing an increase in healthcare costs.
“Drugs are cheap and generic, and they will stave off the other problems,” he said.
Cigarroa is talking about stroke and heart attack. High blood pressure is one of the leading causes of both diseases, which make up a significant portion of all healthcare costs.
Treatment of cardiovascular disease accounts for $1 of every $6 that is spent on healthcare, according to the U.S. Centers for Disease Control and Prevention (CDC).
In 2010, an estimated $444 billion was spent on cardiovascular disease treatment, medication, and lost productivity due to disability.
Using medication that keeps blood pressure in check and stops the development of stroke or heart attack will ultimately save costs, Cigarroa added.
“Overall there is a net cost savings,” he said. “It’s not going to lead to higher costs.”
There’s no question that the costs associated with the new hypertension guidelines has yet to be sorted out.
But until then, doctors and patients are expected to forge a united front, a team effort, if you will, to treat the life-threatening disease.
“The guidelines, they set up a high standard for us,” Dajani said. “High blood pressure is a big risk factor for many diseases. I hope we prevent the complications, but it’s a tall order.”