Clinical Guideline Recommends Less Aggressive Hypertension Goals

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Hypertension treatment may begin when adults aged 60 years and older have a persistent SBP at or above 150 mm Hg.
Hypertension treatment may begin when adults aged 60 years and older have a persistent SBP at or above 150 mm Hg.

HealthDay News – Two leading medical organizations are recommending a less aggressive target for the treatment of hypertension in adults aged 60 years and older who are otherwise healthy. The new clinical practice guideline was published online in the Annals of Internal Medicine.

The new guideline says doctors should now begin treatment when adults aged 60 years and older have persistent systolic blood pressure at or above 150 mm Hg, to reduce their risk of cardiovascular events, stroke, and death.

A less aggressive target like this offers a suitable balance of benefits and potential harms for these patients, according to the new guideline from the American College of Physicians and the American Academy of Family Physicians. Any additional benefit from more aggressive treatment is small, the groups say.

Exceptions include recommendations for adults aged 60 years and older with a history of stroke or transient ischemic attack. Doctors should aim to achieve a systolic blood pressure of less than 140 mm Hg, to reduce these patients' risk of recurrent stroke. Based on individual assessment, doctors should also consider doing the same for adults aged 60 years and older who are deemed to be at high risk for cardiovascular events, according to the guidelines.

References

  1. Qaseem A, Wilt TJ, Rich R, et al; for the Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher vs lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians [Published online January 17, 2017]. Ann Intern Med. doi:10.7326/M16-1785
  2. Weiss J, Freeman M, Low A, et al. Benefits and harms of intensive blood pressure treatment in adults aged 60 years or older: a systematic review and meta-analysis [Published online January 17, 2017]. Ann Intern Med. doi:10.7326/M16-1754 
  3. Pignone M, Viera AJ. Blood pressure treatment targets in adults aged 60 years or older [Published online January 17, 2017]. Ann Intern Med. doi:10.7326/M17-0034
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