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Could new blood pressure guidelines harm employees & waste money?

Updated: Jan 15



Few things create as much employee stress as being told they have a chronic condition, such as high blood pressure. High blood pressure does increase the risk heart attack or stroke, but from a very low base: if you check your data from 2017, you’ll find that only roughly 2 of every 1000 people you cover actually suffered a stroke or heart attack. The cost of preventing one of those events through “outcomes-based” blood pressure wellness programs?About a million dollars...if it can be done at all.


And yet now the medical care industry is advising us to spend even more money trying to reduce the irreducible.


For years, clinicians were told to manage patients (through lifestyle changes and/or medication) to a threshold of 140/90. But in late 2017, the American Heart Association took the dramatic step of lowering the bar for what is considered a healthy blood pressure to 120/80, which instantly made over 30 million more American adults (including many of your employees) into patients who ostensibly need physician visits and drugs.


Unfortunately, the truth about risk is not so clear. Two large and influential medical groups – the American Academy of Family Physicians and the American College of Physicians – publicly disagreed with the new AHA standard, especially in regards to older adults (over 60). They rightly observed that the new AHA guideline implies a linear relationship between blood pressure and heart attacks/strokes. Quite the opposite: if all your employees who are now at 140/90 went to 120/80, it would be doubtful if the very largest organizations, over a long period of time, would even be able to discern a difference in events attributable to this reduction.


At what cost to employee health?

Attempting to reach that new threshold may even harm employees. According to a review of data in nearly 10,000 patients with established heart disease, carried out by the internationally acclaimed Cochrane Collaboration, lower treatment targets (under 135) did not result in fewer deaths, heart attacks or strokes compared to standard targets. Those patients who managed to achieve the lower blood pressure targets also had more adverse effects related to the medication itself. There could also be a safety issue, as too much blood pressure medicine could lead to fainting spells on the job.


What’s an employer to do?

Strokes? Heart attacks? Adverse effects? Fainting spells? What should you and your employees do to balance the theoretical long-term harms of slightly elevated blood pressure against the possible short-term harms of too much medication?


Helping employees understand what questions to ask, when to ask them, and how to interpret what they’re told in the clinic is the single biggest step any employer can take to both keep employees safe from inappropriate or useless treatment and build their confidence about handling medical information.


For instance, Quizzify covers questions like:

● What if I miss a dose? Do I take two?

● How do I know if I am taking too much or not enough?

● What interactions might these drugs have with others?

● How do I know if this is the right drug for me?

● Does the right dose depend on my weight?


Employers and employees are right to be skeptical about changes in treatment guidelines for common problems, especially when there are credible, evidence-based arguments that the changes will not lower mortality or reduce morbidity. After all, when physicians need to be reminded in the guidelines about how to simply take blood pressure correctly, it’s much wiser to take a go-slow approach to embracing a lifetime of clinical engagement for employees whose blood pressures are in a gray zone.


Maintaining weight, building fitness, and improving diet quality (for example, through eating more fruits and vegetables) comes first, for high blood pressure and a host of other lifestyle diseases. Quizzify’s approach to addressing health literacy is built upon ensuring that employees learn first and foremost how to improve their lives by making healthier lifestyle choices. Not by lecturing at them, but by helping them to identify hidden sugars, read ingredients labels, understand the nuances of salt and health, and consider alternatives to popular drugs (such as Prevacid, Prilosec and Nexium) that have been suspected of causing cardiac events.


As Harvard researchers showed in a major study published earlier this year, improving healthy lifestyle choices in five areas—all of which Quizzify teaches about—could add a decade to the lifespan of the typical American adult.