Monday, January 22, 2018

Latest ACC/AHA hypertension guidelines recommend too many patients for drug treatment

The latest hypertension guidelines from the American College of Cardiology and the American heart Association (ACC/AHA) revise blood pressure classifications, thereby increasing the prevalence of hypertension by about 14 percent in the United States. Under the new guidelines, a reading of 120-129/<80 130-139="" a="" and="" considered="" guidelines="" hg="" hypertensive.="" i="" in="" is="" mm="" of="" prehypertensive="" published="" reading="" synopsis="" the="">Annals of Internal Medicine
The new guidelines differ significantly from several published guidelines, including those developed by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). According to Amir Qaseem, MD, PhD, Vice President of ACP's Clinical Policy and Center for Evidence Reviews, the ACC/AHA recommendations place too many patients in the hypertensive category, subjecting them to treatment. This approach falls short in weighing the potential benefits against potential harms, costs, and individual patient preferences.

ACP believes that pharmacologic initiation and treatment targets of less than 130/80 mm Hg in a broad population of older adults is not strongly supported by evidence and may result in low value care for several reasons. First, clinical trials do not provide consistent evidence of benefit of SBP targets less than 130 mm/Hg in older adults, including those with diabetes or kidney disease. Second, trials often overestimate the benefits and underestimate harms seen when findings are applied to broad primary care populations. And third, there is no RCT evidence to support a DBP target of less than 80 mm Hg.

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