Wednesday, January 18, 2017
Initiate treatment in adults 60 years old and older with persistent systolic blood pressure at or above 150 millimeters
The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have published an evidence-based clinical practice guideline on the appropriate systolic blood pressure (the top number in a reading) target for adults 60 years old and older with hypertension. The physicians' groups say that a less aggressive target provides a good balance of benefits and harms for older adults who are otherwise healthy. The joint guideline is published in Annals of Internal Medicine and a summary of the guideline will be published in Annals of Family Medicine.
ACP and AAFP recommend that physicians initiate treatment in adults aged 60 years old and older with persistent systolic blood pressure at or above 150 millimeters of mercury (mmHg) to reduce the risk of mortality, stroke, and cardiac events. The evidence suggests that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes. Some patients may have falsely elevated readings in clinical settings, which is known as "white coat hypertension," therefore, it is important for physicians to ensure that they are accurately measuring blood pressure before initiating or changing treatment. The most accurate measurements come from multiple blood pressure measurements made over time in clinical settings or at home.
The guidelines recommend that physicians consider initiating or intensifying drug therapy in adults aged 60 years old and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of recurrent stroke. Physicians should also consider initiating or intensifying pharmacological treatment in some adults aged 60 years old and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk of stroke or cardiac events.
Hypertension, an elevation of systemic arterial blood pressure, is one of the most common chronic diseases in the United States. About 65 percent of adults in the U.S. over the age of 60 have hypertension, and the disease affects about 29 percent of all adults in the nation. ACP and AAFP are two of the largest physician organizations in the U.S. representing primary care doctors. Their combined 420,900 members, including internal medicine physicians (internists) and family physicians, treat the majority of patients in the U.S. with hypertension.