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 ) .
Intensive Blood Pressure Control, Falls, and Fractures in Patients with Type 2 Diabetes: The ACCORD Trial
ABSTRACT BACKGROUND There are few rigorous studies to confirm or refute the commonly cited concern that control of blood pressure to lower thresholds may result in an increased risk of falls and fractures . OBJECTIVE To compare falls and fractures in participants with type 2 diabetes in the intensive ( targeting a systolic blood pressure of < 120 mmHg ) and st and ard ( targeting a systolic blood pressure of < 140 mmHg ) blood pressure control arms of the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) r and omized trial ( N = 4,733 ) . PARTICIPANTS A subset of 3,099 participants self-reported annually on the occurrence of falls and non-spine fractures . Fractures were central ly adjudicated . MAIN MEASURES The incidence of falls in the two treatment groups was compared using a r and om-effects negative binomial model , and fracture risk was compared using Cox proportional hazards models . KEY RESULTS At enrollment in both groups , the mean age was 62 years , 44 % were women , 25 % were Black , and mean blood pressure was 138/75 mmHg . During follow-up , all classes of medications , particularly thiazide diuretics , were more commonly prescribed in the intensive group . After 1 year of follow-up , the mean systolic blood pressure was 133 ± 15 mmHg in the st and ard group and 119 ± 14 mmHg in the intensive group . The adjusted rate of falls did not differ in the intensive and st and ard groups ( 62.2/100 person-years vs. 74.1/100 person-years , RR = 0.84 , 95 % CI 0.54–1.29 , p = 0.43 ) . The risk of non-spine fractures was nonsignificantly lower in the intensive than in the st and ard blood pressure group ( HR 0.79 , 95 % CI 0.62–1.01 , p = 0.06 ) . CONCLUSIONS We conclude that intensive antihypertensive treatment that lowered mean systolic blood pressure to below 120 mmHg was not associated with an increased risk of falls or non-spine fractures in patients age 40 to 79 years with type 2 diabetes
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 ) .