NEW guidelines from the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) has recommended that doctors use a less aggressive threshold for treating high blood pressure, or hypertension, in otherwise healthy adults aged 60 and above if their systolic blood pressure persistently reads 150 mm Hg or higher, in order to reduce the risk of death, stroke, and cardiac events. Traditionally, the threshold for systolic blood pressure (the upper reading) above which doctors consider prescribing treatment has been 140 mm Hg. The two groups issued the new guideline following a review of the evidence on the benefits and harms of higher versus lower blood pressure thresholds for the treatment of hypertension in adults aged 60 and older. The joint guideline and details of the evidence review are published online in Annals of Internal Medicine. A summary will also appear in the March/April 2017 issue of Annals of Family Medicine. To arrive at the new guidelines, the groups carried out a systematic review of randomized controlled trials and observational studies. They looked for studies published from the start of database records to January 2015, and updated the list up to September 2016. They evaluated the evidence by analyzing deaths from all causes, together with illnesses, harms, and deaths linked to stroke and major cardiac events, including fatal and non-fatal heart attacks and sudden cardiac death. There was not enough evidence to make recommendations about diastolic blood pressure targets. ‘Small benefit from additional aggressive treatment’  ACP President Nitin S. Damle has said that the evidence suggests that any additional benefit from aggressive treatment of high blood pressure is small, “with a lower magnitude of benefit and inconsistent results across outcomes.” The most accurate blood pressure readings come from measurements made over a period of time, either in the clinic or at home, they add. The guidelines also contain two recommendations where the threshold target for systolic blood pressure should be 140 mm Hg. These concerns when to consider initiating or intensifying drug therapy for patients aged 60 and older with certain histories or conditions. This could be to reduce risk of recurrent stroke in patients with a history of stroke or transient ischemic attack (otherwise known as a ministroke) or, based on individual assessment, to reduce risk of stroke or cardiac events in some patients at high cardiovascular risk.

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