Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
ACC/AHA guidelines take more aggressive, less evidence-based approach to hypertension management
Clinical Question
What changes to hypertension management are proposed by the 2017 guideline from the American College of Cardiology and the American Heart Association?
Bottom line
This guideline from the American College of Cardiology and the American Heart Association (ACC/AHA) labels all patients with a blood pressure greater than 130/80 as hypertensive, and methodologically takes a step back from the 2014 Joint National Committee 8 guidelines by focusing more on observational studies and disease-oriented outcomes to support their recommendations, and by extending the Systolic Blood Pressure Intervention Trial (SPRINT) findings to patients with diabetes, lower cardiovascular risk, and chronic kidney disease. The United States is in the midst of a "society war," pitting primary care professional societies against subspecialty societies regarding the definition of hypertension, when to begin treatment, and blood pressure treatment goals. In fact, this guideline was explicitly not endorsed by the American Academy of Family Physicians (AAFP). This conflict illustrates the problem with practice guidelines: Who is on the committee, how they assess the studies, and the types of outcomes they consider can result in different recommendations. If you choose to use a blood pressure target of 130/80 mmHg for your patients with diabetes, chronic kidney disease, or a greater than 10% 10-year risk of a cardiovascular event, it is critical that you measure blood pressure the same way that it was measured in the SPRINT trial (have the patient sit in a quiet room for 5 minutes before testing, then use the average of 3 mechanically measured blood pressures). 5
Reference
Study design: Practice guideline
Funding: Foundation
Setting: Various (guideline)
Synopsis
0
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Can ‘holistic’ ever be applied to guidelines evaluation? Is there any type of knowledge worthy of considering beyond rct? Maybe we all need to re-read “Voltaire’s Bastards” by John Raulston Saul about the risks of extreme adherence to Cartesian logic. There may be more.
good poem
This certainly points to the simple fact that guidelines are in truth....political statements
Not dissatisfied with the reviewers comments but I am with the politics going on behind this. Many practitioners of alternative medicine do not have much good to say about "evidence -based" medicine. This is a great example that support their perspective. This article will not stimulate me to make a single change to my practice.
I'm glad this was not endorsed by the AAFP. My practice will not change.
The so called guidelines issued by various specialist groups ignore the real-life practicalities that most patients face. How may broken hips will result from applying these ridiculous guidelines to seniors? What will happen to quality of life for all the 50-60 year old men with ED from applying the guidelines?
Frankly, as a FP I ignore most of the guidelines and follow the advice laid out in Therapeutics Initiative which is succint and objective (and practical)
See Henry Mintzberg's comments on CBC Radio's 'Sunday Morning' (Feb 4, 2018)
Do these guys look after patients?!
Balanced look at benefits and harms of over-treatment of this vital sign. Harms are too often overlooked in pursuit of satisfying specialty-imposed criteria. Patients, their families, and Family Physicians are the ones left to deal with the outcomes of well intentioned clinical goals.
bad poem bad advise
I am all for doing clinical study to determine the best approach in diagnosing disease and recommend treatment . But this study and recommendation borders on ivory tower approach . North America is already an over medicated society and we should be more aware of the risk of over treatment.
The POEM is better than the guideline!
Whisky Tango Foxtrot - another guideline which will likely change in the next three years - we all need more guidelines - it may end when we are all cyborgs
Wow! Dissent amongst the ranks!
This is interesting as it is showing how different people can take the same information and see different conclusions from it.
Some people are likely to derive better outcomes from more aggressive BP control but truly who is a big question.
Do we need to pay attention to how we measure what we treat to make sure we are doing the correct thing? I think so.
Does more aggressive Rx lead to more drugs and more cost (for them but we don't know if we save in other areas in the long term) and more potential side effects...YES.
This question is not going away.
This debate is here to stay.
Maybe a trial to show how we should MEASURE blood pressure would be good.