Hypertension Limbo: Balancing Benefits, Harms, and Patient Preferences Before We Lower the Bar on Blood Pressure

Editorials6 March 2018Hypertension Limbo: Balancing Benefits, Harms, and Patient Preferences Before We Lower the Bar on Blood PressureTimothy J. Wilt, MD, MPH, Devan Kansagara, MD, MCR, and Amir Qaseem, MD, PhD, for the Clinical Guidelines Committee of the American College of PhysiciansTimothy J. Wilt, MD, MPHMinneapolis VA Health Care System, Minneapolis, Minnesota (T.J.W.), Devan Kansagara, MD, MCRPortland Veterans Affairs Medical Center, Portland, Oregon (D.K.), and Amir Qaseem, MD, PhDAmerican College of Physicians, Philadelphia, Pennsylvania (A.Q.), for the Clinical Guidelines Committee of the American College of PhysiciansAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3293 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The recent hypertension guideline from the American College of Cardiology (ACC), the American Heart Association (AHA), and partner organizations—a synopsis of which is in this issue (1)—raises important questions about hypertension diagnosis and treatment. The guideline differs substantially from those of other organizations, including the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) (2). Here, we examine these differences, focusing on pharmacologic treatment of adults older than 60 years. Strengths of the ACC/AHA guideline include its emphasis on the importance of blood pressure (BP) measurement technique and lifestyle changes. However, the guideline falls short in ...References1. Carey RM, Whelton PK; 2017 ACC/AHA Hypertension Guideline Writing Committee. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline. Ann Intern Med. 2018;168:351-8. doi:10.7326/M17-3203 LinkGoogle Scholar2. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA; 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 versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430-7. [PMID: 28135725]. doi:10.7326/M16-1785 LinkGoogle Scholar3. Doust J, Vandvik PO, Qaseem A, Mustafa RA, Horvath AR, Frances A, et al; Guidelines International Network (G-I-N) Preventing Overdiagnosis Working Group. Guidance for modifying the definition of diseases: a checklist. JAMA Intern Med. 2017;177:1020-5. [PMID: 28505266] doi:10.1001/jamainternmed.2017.1302 CrossrefMedlineGoogle Scholar4. Welch HG, Schwartz LM, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Pr; 2011:1-31. Google Scholar5. Haynes RB, Sackett DL, Taylor DW, Gibson ES, Johnson AL. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 1978;299:741-4. [PMID: 692548] CrossrefMedlineGoogle Scholar6. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-16. [PMID: 26551272] doi:10.1056/NEJMoa1511939 CrossrefMedlineGoogle Scholar7. Wei Y, Jin Z, Shen G, Zhao X, Yang W, Zhong Y, et al. Effects of intensive antihypertensive treatment on Chinese hypertensive patients older than 70 years. J Clin Hypertens (Greenwich). 2013;15:420-7. [PMID: 23730991] doi:10.1111/jch.12094 CrossrefMedlineGoogle Scholar8. Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, et al; HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2009-20. [PMID: 27041480] doi:10.1056/NEJMoa1600175 CrossrefMedlineGoogle Scholar9. Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998;351:1755-62. [PMID: 9635947] CrossrefMedlineGoogle Scholar10. Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556-64. [PMID: 12700376] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Minneapolis VA Health Care System, Minneapolis, Minnesota (T.J.W.)Portland Veterans Affairs Medical Center, Portland, Oregon (D.K.)American College of Physicians, Philadelphia, Pennsylvania (A.Q.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3293.Corresponding Author: Amir Qaseem, MD, PhD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Dr. Wilt: Minneapolis VA Health Care System, 1 Veterans Drive (111-0), Minneapolis, MN 55417.Dr. Kansagara: Portland Veterans Affairs Medical Center, Mailcode RD71, 3710 SW US Veterans Hospital Road, Portland, OR 97239.Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.This article was published at Annals.org on 23 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Resource for Practicing Clinicians Robert M. Carey and Paul K. Whelton Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline Robert M. Carey , Paul K. Whelton , and Annals On Call - Hypertension Limbo Robert M. 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What do new guides bring up to date? 6 March 2018Volume 168, Issue 5Page: 369-370KeywordsBlood pressureCardiovascular disease riskCardiovascular diseasesDrug therapyElderlyFallsHypertensionMortalityRenal diseasesTreatment guidelines ePublished: 23 January 2018 Issue Published: 6 March 2018 PDF downloadLoading ...

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