For decades, we’ve been told to keep our blood pressure below 140/90. Now: New expert guidelines have plenty of doctors crying foul. According to these relaxed recommendations, people over age 60 don’t need treatment until systolic (top number) blood pressure rises to 150 or higher (no change was recommended for diastolic pressure). For people under age 60, 140/90 still is the cutoff.

Why the change? The committee that created the guidelines concluded that there isn’t enough evidence that the additional blood pressure—lowering prevents heart attacks and strokes. In the absence of benefit, the risk for side effects from medication is not justified. Samuel Mann, MD, a hypertension specialist at NewYork-Presbyterian Hospital and author of Hypertension and You (Rowman & Littlefield), disagrees. He says…

Most of the studies analyzed by the committee followed patients for only three to five years—not long enough to observe the benefits of lowering systolic pressure to 140 versus 150.

Blood pressure reduction also has other long-term benefits that would not be evident in a three-to-five-year study, such as lower risk for dementia, erectile dysfunction and other vascular-related conditions.

With the many excellent medications available today, we usually can get the systolic pressure under 140 without side effects.

Dr. Mann’s takeaway: A target below 140/90 still is best for most adults. One exception: Adults age 80 and older may do better with systolic pressure of up to 160.