ACP, AAFP Release Joint Updated Hypertension Guidelines

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have released updated hypertension practice guidelines on systolic blood pressure (SBP) targets for individuals 60 years of age and older. The new guidelines put forth a looser diagnostic treatment threshold for average and low-risk adults.

The joint report, published in the Annals of Internal Medicine, outlines evidence-based clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for older adults with hypertension.

The guidelines recommend treatment initiation in adults aged 60 years or older with persistent systolic blood pressure at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg. This recommendation received a strong rating, with high quality evidence.

The ACP and AAFP also recommend that clinicians initiate or intensify pharmacologic treatment in older adults with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg. This recommendation had moderate-quality evidence, and was rated as weak.

Clinicians are also encouraged to consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, according to the guidelines, based on individualized assessment to achieve a target systolic blood pressure of less than 140 mm Hg.

A supporting evidence review concluded that treatment to at least current guideline standard for BP substantially improves health outcomes in older adults with hypertension, although there is less consistent evidence that lower SBP targets (less than 120 mm Hg) are beneficial for high-risk patients. Data showed high-strength evidence pointing toward BP control of less than 150/90 mm Hg to reduce mortality, cardiac events, and stroke.

References

Qaseem A, Wilt TJ, Rich R, et al. 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; doi:10.7326/M16-1785

Weiss J, Freeman M, Low A, et al. Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older: A Systematic Review and Meta-analysis. Ann Intern Med. 2017; doi:10.7326/M16-1754