blood pressure targets 2017.still struggling for the right answer
TRANSCRIPT
Blood Pressure TargetsWhat Do the New Guidelines Say ?
Achieving BP goals in hypertensive patients
The most clinically relevant
measure of BP control.
On March 31, 2015, the AHA, the ACC, and the ASH issued a new scientific statement
entitled “Treatment of Hypertension in Patients with Coronary Heart Disease.”
The multitude of guidelines from respected professional bodies and individuals have caused,
in my opinion , needless confusion bordering on chaos.
C. Venkata S. Ram, MD The Journal of Clinical Hypertension Vol 16 | No 4 | April 2014
A Flurry of Guidelines for High Blood Pressure Management
“Flurry of guidelines, which offer different
recommendations on BP targets.”
*ADA: < 140/80
**KDIGO: <140/90 w/o albuminuria
≤130/80 if >30 mg/24hr
Hypertension Goals of Various Organizations
Class/Level of EvidenceConditionBP Goal (mmHg)
IIa/BAge >80 years< 150/90
I/AIIa/CIIa/B
CADACSHF
< 140/90
IIb/CIIb/C
CADPost-MI, stroke, TIA
CAD, PAD, AAA
< 130/80
March 31, 2015
Goals for target BP level or reduction from pretreatment baseline are uncertain and should be individualized, but it is reasonable to achieve a SBP<140 mm Hg and a DBP<90 mm Hg
(Class IIa; Level of Evidence B). For patients with a recent lacunar stroke, it might be
reasonable to target a SBP of <130 mm Hg(Class IIb;Level of Evidence B).
Blood pressure targets:are clinical guidelines wrong?
JNC 8 Headlines
Despite Controversy, JNC 8 Guideline Provides Much-needed Standards for Hypertension Management
The JNC 8 Hypertension Guidelines: An In-Depth Guide
A call to retract the JNC-8 hypertension guidelines
Hypertension Guidelines: Clear as Mud
The recent publication of the SPRINT has again opened the debate on optimal BP targets.
Does SPRINT change our approach to BP targets?
Outcomes Data from SPRINT and the ACCORD Trial and Combined Data from Both Trials.
In both the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, the systolic blood-pressure target in the intensive-treatment group was less than 120 mm Hg, and the target in the standard-treatment group was less than 140 mm Hg.
The early release of SPRINT results has not been accompanied by a similar change in treatment guidelines. The exception is the Canadian Hypertension
Education Program (CHEP) guidelines, which are updated annually
The state of CHEP guidelinespre-SPRINT post-SPRINT
3 Clinical or sub-clinical CVD,CKD (non-diabetic nephropathy, proteinuria <1 g/d, or eGFR20-59 mL/min/1.73m2),Estimated 10-year global cardiovascular risk >15%.Age ≥ 75 years.
1 Elderly defined as > 80 years age, non-diabetic, with no CKD
Hypertension in 2017—What Is the Right Target?
Updated Hypertension Guidelines Released by ACP, AAFP
(published online January 17 in the Annals of Internal Medicine.)
Recommendation 1: ACP and AAFP recommend that clinicians initiate
treatment in adults aged 60 years or older with
systolic blood pressure persistently at or above 150
mm Hg to achieve a target systolic blood pressure
of less than 150 mm Hg to reduce the risk for
mortality, stroke, and cardiac events.(Grade : strong recommendation, high-quality evidence).
Recommendation 2:ACP and AAFP recommend that clinicians
consider initiating or intensifying pharmacologic
treatment in adults aged 60 years or 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 for recurrent
stroke. (Grade : weak recommendation, moderate-quality evidence).
Recommendation 3: ACP and AAFP recommend that clinicians
consider initiating or intensifying pharmacologic
treatment in some adults aged 60 years or 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 for stroke or cardiac events. (Grade : weak recommendation, low quality evidene).
Clinicians should individually assess cardiovascular risk for patients.Generally , increased cardiovascular risk includes persons with known vascular disease,
most patients with diabetes , older persons with chronic kidney disease with eGFR less than 45 mL/min/per 1.73 m2, those with metabolic syndrome (abdominal obesity, hypertension, diabetes, and dyslipidemia),and older persons.