Hypertension Guidelines - Controversy continues
What the ACP/AAFP Guidelines say -
The latest Hypertension Guidelines, from the American College of Physicians and the American Academy of Family Physicians and published in the Annals of Internal Medicine recommend a looser diagnostic and treatment threshold of below 150 mm Hg systolic for average and lower-risk adults age 60 and older.
For adults age 60 and older with prior stroke or TIA or otherwise high cardiovascular risk, the ACP/AAFP recommend a systolic goal of less than 140 mm Hg
This new recommendation is very similar to JNC 8 Guideline of 2013 which led to a huge outcry amongst physicians and cardiologists
What the AHA/ACC Guidelines say -
ACC/AHA continue to recommend the JNC7 recommendation of 140 mm Hg as a diagnostic threshold and treatment target.
What was the SPRINT Trial?
The SPRINT Trial conducted in 2016 included 9,361 people over 50 who had an initial Systolic Blood Pressure between 130 and 180 and above-average cardiovascular risk. Some aimed for a blood pressure target of 140 while others aimed for 120. Participants with a blood pressure target of 140 had a 6.8 percent chance of a cardiovascular event or death over three years. With a target of 120, their risk dropped to 5.2 percent. The trial showed benefits of an intensive goal of less than 120 mm Hg in people 75 and older as well as in frail individuals.
What does all this mean for clinicians?
While the new ACC/AHA Guidelines will come out later this year, experts say that they have always been looking for a 'magic number' that we could apply widely to the population, but more and more clinical trials have been done on specific groups of patients -- diabetics, non-diabetics, older, middle age, with cardiovascular disease, without, etc. -- and we are learning that perhaps 'one-size fits all' is not the way to approach patients with hypertension.