Leading Physician Organizations Issue New Guideline for Treating Hypertension in Older Adults

Leading Physician Organizations Issue New Guideline for Treating Hypertension in Older Adults

There is a new clinical practice guideline for the treatment of hypertension, often associated with chronic kidney disease (CKD), thanks to the joint work of two leading physician organizations, namely the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).

The evidence-based guideline revises the appropriate systolic blood pressure levels for adults 60 years and older. (Systolic is the “top” number of a blood pressure reading.)

The new document was published in the Annals of Internal Medicine under the title “Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets.”

Hypertension refers to an elevated systemic arterial blood pressure, and is one of the most frquent chronic conditions in the United States, affecting nearly 65% of older American adults and 29% of the general adult population.

The new guideline recommends that patients with hypertension should try to reach a pressure of lower than 150 mm Hg. To achieve this, treatment for adults older than 60 years of age who have persistent systolic blood pressure should begin at 150 mm Hg, to reduce the risk of mortality, stroke and cardiac events.

The ACP and AAFP developed the guideline after systematically reviewing published randomized, controlled trials for primary outcomes and observational studies for harms only from database inception through January 2015. The database was updated with a MEDLINE search through September 2016.

Outcomes included in the evaluation were all-cause mortality, morbidity and mortality associated with stroke, major cardiac events and harms.

“The evidence showed that any additional benefit from aggressive blood pressure control is small, with a lower magnitude of benefit and inconsistent results across outcomes,” Nitin S. Damle, MD, president of the ACP, said in a press release. “Most benefits of targeting of less than 150 mm Hg apply to individuals regardless of whether or not they have diabetes.”

Besides revising target pressure levels, the organizations analyzed reading practices and concluded it is vital to follow patients who present elevated readings over time, to avoid what sometimes is called “white coat hypertension,” or falsely elevated readings brought on by the patient being nervous.

“The most accurate measurements come from multiple blood pressure measurements made over time,” added John Meigs, Jr., MD, president of the AAFP. “These may include multiple measurements in clinical settings or ambulatory or home-monitoring.”

In addition, the guideline suggests that physicians consider prescribing generic medications more often because the lower costs could improve patients’ adherence.

A summary of the guideline will be published in the March/April issue of the Annals of Family Medicine.

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