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 ) .
Systolic Hypertension in Europe (Syst-Eur) Trial Phase 2: objectives, protocol, and initial progress
The Systolic Hypertension in Europe ( Syst-Eur ) trial proved that blood pressure ( BP ) lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in older ( ⩾60 years ) patients with isolated systolic hypertension ( systolic BP ⩾160 mm Hg and diastolic BP < 95 mm hg ) . after the completion of the syst-eur trial on 14 february 1997 , 3506 consenting patients ( 93.0 % of those eligible ) were enrolled in phase 2 of the syst-eur trial . this open follow-up study aims to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine . to lower the sitting systolic bp below 150 mm hg ( target bp ) , the first-line agent nitrendipine ( 10–40 mg/day ) may be associated with enalapril ( 5–20 mg/day ) , hydrochlorothiazide ( 12.5–25 mg/day ) , both add-on study drugs , or if required any other antihypertensive agent . on 1 november 1998 , 3248 patients were still being followed , 86 patients had proceeded to non-supervised follow-up , and 43 had died . the median follow-up in syst-eur 2 was 14.3 months . at the last available visit , systolic/diastolic bp in the patients formerly r and omised to placebo ( n = 1682 ) or active treatment ( n = 1824 ) , had decreased by 13.2/5.2 mm Hg and by 4.6/1.6 mm Hg , respectively , so that the between-group BP difference was 1.7 mm Hg systolic ( 95 % Cl : 0.8 to 2.6 mm Hg ; P < 0.001 ) and 0.9 mm hg diastolic ( 95 % cl : 0.4 to 1.5 mm mm hg ; P < 0.001 ) . at the beginning of syst-eur 2 , the goal bp was reached by 25.4 % and 50.6 % of the former placebo and active-treatment groups ; at the last visit these proportions were 55.9 % and 63.1 % , respectively . at that moment , 45.9 % of the patients were on monotherapy with nitrendipine , 29.3 % took nitrendipine in combination with other study drugs . until the end of 2001 , bp control of the syst-eur 2 patients will be further improved . cardiovascular complications and adverse events , such as cancer or gastro-intestinal bleeding , will be monitored and vali date d by blinded experts
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 ) .