Hypertension

ACP and AAFP Release New Hypertension Guidelines

The American College of Physicians and the American Academy of Family Physicians have issued new guidelines for the treatment of hypertension in adults 60 years or older.

The new guidelines are intended to provide clinical evidence on the benefits and harms of high and low blood pressure. They were created based on assessment of harm outcomes in published randomized, controlled trials, and focus on pharmacological interventions.
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The guidelines recommend clinicians assess and treat patients using the following blood pressure measurements:

  • In adults aged 60 or older with systolic blood pressure continually at or above 150 mm Hg, clinicians should begin treatment to achieve less than 150 mm Hg target blood pressure. Clinicians are recommended to select treatment goals based on discussion of benefits and harm of specific blood pressure targets in patients. (strong recommendation, high-quality evidence).
     
  • In adults aged 60 or older with a history of stroke or transient ischemic attack, clinicians should consider starting or intensifying pharmacologic treatment to achieve a systolic blood pressure of less than 140 mm HG. Treatment goals should be selected based on periodic discussion of harm and benefits of specific blood pressure target with patients (weak recommendation, moderate-quality evidence).
     
  • In adults aged 60 or older with a high cardiovascular risk, clinicians should start or intensify pharmacologic treatment to achieve a target systolic blood pressure of less than 140 mm Hg, and should base treatment goals on discussions about the benefits and harms of specific blood pressure targets with patients. (weak recommendation, low-quality evidence).

“In addition, when selecting [blood pressure] targets for adults aged 60 years or older, clinicians need to consider comorbid conditions that could affect treatment choice,” the researchers stated.

“Clinicians should consider the patient's treatment burden when deciding on treatment options,” the researchers concluded.

—Melissa Weiss

Reference:

Qaseem A, Wilt TJ, Rich R, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher verses lower blood pressure targets: a clinical practice guidelines from the American College of Physicians and the American Academy of Family Physicians [published online January 17, 2017]. Journal of American College of Cardiology. doi:10.7326/M16-1785.