Published on the NPR web site:
There has been a carefully guarded secret in medicine: Evidence is often inconclusive, and experts commonly disagree about what it means.
Most medical decisions aren’t cut and dried. Instead they’re usually made with uncertainty about what is best for each person.
This uncertainty secret has been revealed in a very public disagreement among experts about who should be treated for high blood pressure. The controversy hinges on the level of blood pressure that should serve as a trigger for treatment.
The says that people 60 years and older can seek a (the top number) of 150 or less. The old guidelines says that 140 or less should be the goal.
But now some experts who were part of the group responsible for the new advice seem to have changed their minds. They’re that still bear their names and saying the old, lower treatment goal is the one to follow.
To be clear, there is strong evidence and little disagreement in many areas related to the treatment of high blood pressure. For example, there is strong agreement that it is preferable to use lifestyle interventions rather than medications. Diet and exercise should always be the first option.
And there is also agreement about the large benefit for patients from the treatment of very high blood pressure. But what is notable right now is that a fundamental recommendation about what should be the goal of therapy is no longer considered to be a treatment tenet that can’t be violated. There is open disagreement about it.