Benefits of Treating Higher Versus Lower BP Targets in Older Adults Across all trials , treating high BP in older adults was beneficial .
This is probably related to the higher frequency of cardiovascular events seen in these patients .
Treatment Effects According to Diastolic BP Evidence was insufficient to determine the benefit of treating diastolic hypertension in the absence of systolic hypertension .
A subgroup analysis of SPRINT showed a nonstatistically significant increase in the rate of serious adverse events , hypotension , syncope , electrolyte abnormalities , or acute
Hypertension , an elevation of systemic arterial blood pressure ( BP ) , is a very common chronic disease in the United States .
The overall prevalence of hypertension among U.S. adults is 29.0 % , and it increases to 64.9 % in adults aged 60 years or older ( 1 ) .
Hypertension was associated with a total of $ 46 billion in health care services , medications , and missed days of work in the United States in 2011 ( 2 ) .
Appropriate management of hypertension reduces the risk for cardiovascular disease , renal disease , cerebrovascular disease , and death ( 36 ) .
However , determining the most appropriate BP targets , particularly for adults aged 60 years or older , has been controversial .
Debate about the goal for systolic BP ( SBP ) among adults treated for hypertension has intensified , especially in light of recent recommendations ( 7 ) .
In addition , when selecting BP targets for adults aged 60 years or older , clinicians need to consider comorbid conditions that could affect treatment choice .
Original Version ( PDF ) Guideline Focus and Target Population The purpose of this American College of Physicians ( ACP ) and American Academy of Family Physicians ( AAFP ) joint guideline is to present evidence -based recommendations on the benefits and harms of higher ( < 150 mm Hg ) versus lower ( 140 mm Hg ) SBP targets for the treatment of hypertension in adults aged 60 years or older .
These recommendations are based on a background evidence review ( 8) and systematic review sponsored by the U.S. Department of Veterans Affairs ( VA ) ( 9 ) .
Randomised Double-Blind Comparison of Placebo and Active Drugs for Effects on Risks Associated with Blood Pressure Variability in the Systolic Hypertension in Europe Trial
Background In the Systolic Hypertension in Europe trial ( NCT02088450 ) , we investigated whether systolic blood pressure variability determines prognosis over and beyond level . Methods Using a computerised r and om function and a double-blind design , we r and omly allocated 4695 patients ( ≥60 years ) with isolated systolic hypertension ( 160–219/<95 mm Hg ) to active treatment or matching placebo . Active treatment consisted of nitrendipine ( 10–40 mg/day ) with possible addition of enalapril ( 5–20 mg/day ) and /or hydrochlorothiazide ( 12.5–25.0 mg/day ) . We assessed whether on-treatment systolic blood pressure level ( SBP ) , visit-to-visit variability independent of the mean ( VIM ) or within-visit variability ( WVV ) predicted total ( n = 286 ) or cardiovascular ( n = 150 ) mortality or cardiovascular ( n = 347 ) , cerebrovascular ( n = 133 ) or cardiac ( n = 217 ) endpoints . Findings At 2 years , mean between-group differences were 10.5 mm Hg ( p<0.0001 ) for SBP , 0.29 units ( p = 0.20 ) for VIM , and 0.07 mm Hg ( p = 0.47 ) for WVV . Active treatment reduced ( p≤0.048 ) cardiovascular ( −28 % ) , cerebrovascular ( −40 % ) and cardiac ( −24 % ) endpoints . In analyses dichotomised by the median , patients with low vs. high VIM had similar event rates ( p≥0.14 ) . Low vs. high WVV was not associated with event rates ( p≥0.095 ) , except for total and cardiovascular mortality on active treatment , which were higher with low WVV ( p≤0.0003 ) . In multivariable-adjusted Cox models , SBP predicted all endpoints ( p≤0.0043 ) , whereas VIM did not predict any ( p≥0.058 ) . Except for an inverse association with total mortality ( p = 0.042 ) , WVV was not predictive ( p≥0.15 ) . Sensitivity analyses , from which we excluded blood pressure readings within 6 months after r and omisation , 6 months prior to an event or both were confirmatory . Conclusions The double-blind placebo-controlled Syst-Eur trial demonstrated that blood-pressure lowering treatment reduces cardiovascular complications by decreasing level but not variability of SBP . Higher blood pressure level , but not higher variability , predicted risk . Trial Registration Clinical Trials.gov
Benefits of Treating Higher Versus Lower BP Targets in Older Adults Across all trials , treating high BP in older adults was beneficial .
This is probably related to the higher frequency of cardiovascular events seen in these patients .
Treatment Effects According to Diastolic BP Evidence was insufficient to determine the benefit of treating diastolic hypertension in the absence of systolic hypertension .
A subgroup analysis of SPRINT showed a nonstatistically significant increase in the rate of serious adverse events , hypotension , syncope , electrolyte abnormalities , or acute
Hypertension , an elevation of systemic arterial blood pressure ( BP ) , is a very common chronic disease in the United States .
The overall prevalence of hypertension among U.S. adults is 29.0 % , and it increases to 64.9 % in adults aged 60 years or older ( 1 ) .
Hypertension was associated with a total of $ 46 billion in health care services , medications , and missed days of work in the United States in 2011 ( 2 ) .
Appropriate management of hypertension reduces the risk for cardiovascular disease , renal disease , cerebrovascular disease , and death ( 36 ) .
However , determining the most appropriate BP targets , particularly for adults aged 60 years or older , has been controversial .
Debate about the goal for systolic BP ( SBP ) among adults treated for hypertension has intensified , especially in light of recent recommendations ( 7 ) .
In addition , when selecting BP targets for adults aged 60 years or older , clinicians need to consider comorbid conditions that could affect treatment choice .
Original Version ( PDF ) Guideline Focus and Target Population The purpose of this American College of Physicians ( ACP ) and American Academy of Family Physicians ( AAFP ) joint guideline is to present evidence -based recommendations on the benefits and harms of higher ( < 150 mm Hg ) versus lower ( 140 mm Hg ) SBP targets for the treatment of hypertension in adults aged 60 years or older .
These recommendations are based on a background evidence review ( 8) and systematic review sponsored by the U.S. Department of Veterans Affairs ( VA ) ( 9 ) .