Abstract from: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 2016-12-16 17:31AmirQaseemMDPhDMHATimothyWiltMDMPHRobertRichMDLindaHumphreyMDMPHJenniferFrostMDMaryAnnForcieaMDfortheClinicalGuidelinesCommitteeoftheAmericanCollegeofPhysicianstheCommissiononHealthofthePublicandScienceoftheAme Frontiers of Nursing订阅 2016年4期 收藏 Amir Qaseem,MD,PhD,MHA,Timothy J.Wilt,MD,MPH,Robert Rich,MD,Linda L.Humphrey,MD,MPH,Jennifer Frost,MD,Mary Ann Forciea,MD,for the Clinical Guidelines Committee of the American College of Physicians,the Commission on Health of the Public and Science of the American Academy of Family PhysiciansDescription:The American College of Physicians(ACP)and the American Academy of Family Physicians(AAFP)jointly developed this guideline to present the evidence and provide clinical recommendations based on the bene fits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.Methods:This guideline is based on a systematic review of published randomized,controlled trials for primary outcomes and observational studies for harms only(identi fied through EMBASE,the Cochrane Database of Systematic Reviews,MEDLINE,and Clinical Trials.gov),from database inception through January 2015.The MEDLINE search was updated through September 2016.Evaluated outcomes included all-cause mortality,morbidity and mortality related to stroke,major cardiac events(fatal and nonfatal myocardial infarction and sudden cardiac death),and harms.This guideline grades the evidence and recommendations using the GRADE(Grading of Recommendations Assessment,Development,and Evaluation)method.Target Audience and Patient Population:The target audience for this guideline includes all clinicians,and the target patient population includes all adults aged 60 years or older with hypertension.Recommendation 1:ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mmHg to achieve a target systolic blood pressure of less than 150 mmHg to reduce the risk for mortality,stroke,and cardiac events.(Grade:strong recommendation,high-quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.Recommendation 2:ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk for recurrent stroke.(Grade:weak recommendation,moderate-quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.Recommendation 3:ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk,based on individualized assessment,to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk for stroke or cardiac events.(Grade:weak recommendation,low quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.

Amir Qaseem,MD,PhD,MHA,Timothy J.Wilt,MD,MPH,Robert Rich,MD,Linda L.Humphrey,MD,MPH,Jennifer Frost,MD,Mary Ann Forciea,MD,for the Clinical Guidelines Committee of the American College of Physicians,the Commission on Health of the Public and Science of the American Academy of Family Physicians

Description:The American College of Physicians(ACP)and the American Academy of Family Physicians(AAFP)jointly developed this guideline to present the evidence and provide clinical recommendations based on the bene fits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.

Methods:This guideline is based on a systematic review of published randomized,controlled trials for primary outcomes and observational studies for harms only(identi fied through EMBASE,the Cochrane Database of Systematic Reviews,MEDLINE,and Clinical Trials.gov),from database inception through January 2015.The MEDLINE search was updated through September 2016.Evaluated outcomes included all-cause mortality,morbidity and mortality related to stroke,major cardiac events(fatal and nonfatal myocardial infarction and sudden cardiac death),and harms.This guideline grades the evidence and recommendations using the GRADE(Grading of Recommendations Assessment,Development,and Evaluation)method.

Target Audience and Patient Population:The target audience for this guideline includes all clinicians,and the target patient population includes all adults aged 60 years or older with hypertension.

Recommendation 1:ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mmHg to achieve a target systolic blood pressure of less than 150 mmHg to reduce the risk for mortality,stroke,and cardiac events.(Grade:strong recommendation,high-quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.

Recommendation 2:ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk for recurrent stroke.(Grade:weak recommendation,moderate-quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.

Recommendation 3:ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk,based on individualized assessment,to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk for stroke or cardiac events.(Grade:weak recommendation,low quality evidence).ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the bene fits and harms of speci fic blood pressure targets with the patient.