Fishy tales and hypertension guidelines

by Dr Ira Bernstein - 

Fishy tales and hypertension guidelines:

Today I will combine 3 newsworthy items into one. About one week ago, published online in Journal of the American Medical Association (JAMA), was the Cardiovascular Outcome Study, which was a branch of the Age-Related Eye Disease Study 2 (AREDS2). It demonstrated that omega-3 supplementation, in addition to the nutrients for macular degeneration (Vitalux products), in people between the ages of 50 to 85 with macular degeneration, taken for an average duration of 4.8 years, did not reduced the risk of cardiovascular disease, in this studied population. 

There were over 4000 participants in the study. So, from a cardiovascular perspective, there isn't compelling, conclusive evidence that fish oil supplementation reduces cardiovascular events based on this and many other trials. However, another study published in the American Journal of Hypertension, this month, was a meta analysis of randomized control trials of the effects of omega-3 fatty acids and the effects on hypertension. They concluded that EHA+DPA (the essential fatty acids) lower systolic blood pressure modestly and at doses over 2 grams daily, diastolic blood pressure is also modestly reduced. Long term effects are not known in terms of whether this modest blood pressure lowering effect would translate into clinical improvement over many years. We just do not know.

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Carrying on with hypertension management: there has been a significant change in the guidelines for managing hypertension that is hot off the press, again in JAMA online. The authorities in hypertension have relaxed the blood pressure goal in adults aged 60 years and older to 150/90 mm Hg, instead of the previous goal of 140/90 mm Hg. Blood pressure goals were also eased for adults with diabetes and kidney disease. This relaxation is very clinically significant because currently 1 in 4 adults over 60 are currently being treated for hypertension based on the old guidelines. This means that millions of North Americans currently treated for hypertension, no longer require drug therapy. The latest evidence suggests they are not benefiting from treatment at these levels. I don't think too many people will be upset about this change (except for the pharmaceutical industry).