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 ) .
Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension
Background In the outcome trials that provided information on renal function in older hypertensive patients , diuretics and β-blockers were mostly used as first-line drugs . The long-term renal effects of calcium-channel blockers remain unclear . Objective To compare the changes in renal function in 2258 treated and 2148 untreated patients with isolated systolic hypertension , of whom 455 had diabetes mellitus and 390 had proteinuria . Methods We performed a post-hoc analysis of the double-blind placebo-controlled Systolic Hypertension in Europe ( Syst-Eur ) Trial . Active treatment was initiated with nitrendipine ( 10–40 mg/day ) with the possible addition of enalapril ( 5–20 mg/day ) , hydrochlorothiazide ( 12.5–25 mg/day ) , or both , titrated or combined to reduce the sitting systolic blood pressure by at least 20 mmHg , to less than 150 mmHg . The main outcome measures were serum creatinine concentration and creatinine clearance calculated by the formula of Cockroft and Gault . Results Serum creatinine concentration at the time when participants were r and omly allocated to study groups was less than 176.8 μmol/l ( 2.0 mg/dl ) , averaging 88 μmol/l . At the time of the last serum creatinine measurement , the blood pressure difference ( P < 0.001 ) between the two groups was 11.6/4.1 mmHg . In the intention-to-treat analysis ( 11 427 patient – years ) , serum creatinine and the calculated creatinine clearance were not influenced by active treatment . However , in the patients assigned r and omly to receive active treatment , the incidence of mild renal dysfunction ( serum creatinine at least 176.8 mmol/l ) decreased by 64 % ( P = 0.04 ) and that of proteinuria by 33 % ( P = 0.03 ) . Active treatment reduced the risk of proteinuria more in diabetic than in non-diabetic patients : by 71 % , compared with 20 % ( P = 0 . 04 ) . In non-proteinuric patients , active treatment did not influence serum creatinine , whereas in patients with proteinuria at entry to the study , serum creatinine decreased on active treatment ( P < 0 . 001 ) . Furthermore , in on-r and omized treatment comparison stratified for risk at baseline , serum creatinine concentration did not change ( P = 0.98 ) in patients continuing to receive monotherapy with nitrendipine , whereas it increased by 6.73 mmol/l ( P < 0.001 ) in patients who received hydrochlorothiazide alone or in combination with other study medication ( P < 0.001 for difference in trends ) . Conclusions In older patients with isolated systolic hypertension , antihypertensive treatment starting with the dihydropyridine calcium-channel blocker , nitrendipine , did not decrease blood pressure at the expense of renal function and prevented the development of proteinuria , especially in diabetic patients
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 ) .