There are new guidelines recently published addressing the appropriate management of blood pressure and blood pressure targets, as follows:

  • For patients over 60 years of age, the new target systolic blood pressure (top number) is 150 mmHg or lower. The previous recommendation was 140 mmHg or lower.
  • For patients under 60 years of age, the target systolic blood pressure remains at 140 mmHg or lower.
  • In diabetic patients, the goal for the top number continues to be less than 140 mmHg regardless of age.

It was previously thought that the lower the blood pressure, the better. It is now clear that overly strict management of blood pressure can cause problems such as decreased blood flow to the kidneys or the brain, with resultant potential damage to these organs. Thus, it is not necessary to try to achieve blood pressure of 120 mmHg anymore. The above guidelines are appropriate when determining the blood pressure level needed to reduce the risk of future cardiovascular disease.

New guidelines have been formulated by the American College of Cardiology. These no longer stress specific number targets. Previous guidelines have stressed lowering either LDL, or bad cholesterol, or raising HDL, or good cholesterol. Ideally, one should initially try to address the condition with lifestyle and diet change and then, if necessary, medical management with statins or other drugs may be indicated. The new guidelines simplify this process.

  • Anyone with known coronary artery disease should be treated.
  • Anyone with an LDL cholesterol level greater than 190 should be treated.
  • Diabetics between the age of 40 and 75 years of age with an LDL cholesterol level of 70 to 190 should be treated.
  • For all other patients, the decision depends on determining the overall risk of future development of coronary artery disease. This computation is best left for your physician to perform.
  • Clearly, some people will be intolerant to the medications, and treatment will need to be individualized by their physician.
For people who do not have coronary artery disease, or disease in any other arteries, there is no evidence that taking a daily aspirin can prevent a future heart attack. If you do have coronary artery disease or peripheral vascular disease, then in general aspirin is effective at preventing recurrent events. Always consult your physician as to the proper use of aspirin and to verify an aspirin regimen is right for you. It is important to talk to your physician about all of your prescription and nonprescription (OTC) medications before you begin an aspirin regimen because aspirin can interact with other drugs you may be taking.
There is currently no indication that taking fish oil supplements, either omega-3 fatty acids or other types, helps in prevention or treatment of coronary artery disease. If the triglyceride levels are in the thousands, then treatment can be effective in preventing episodes of pancreatitis. There is no reason to take fish oil supplements as an aid in preventing disease; however, they may have other health benefits.
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