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 2016-12-16AmirQaseemMDPhDMHATimothyWiltMDMPHRobertRichMDLindaHumphreyMDMPHJenniferFrostMDMaryAnnForcieaMDfortheClinicalGuidelinesCommitteeoftheAmericanCollegeofPhysicianstheCommissiononHealthofthePublicandScienceoftheAme 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. 杂志排行 《师道·教研》2024年10期《思维与智慧·上半月》2024年11期《现代工业经济和信息化》2024年2期《微型小说月报》2024年10期《工业微生物》2024年1期《雪莲》2024年9期《世界博览》2024年21期《中小企业管理与科技》2024年6期《现代食品》2024年4期《卫生职业教育》2024年10期 Frontiers of Nursing 2016年4期 Frontiers of Nursing的其它文章 GUIDE FOR AUTHORSLeadership theory in clinical practicePerceived health-related stigma among patients with breast cancerCultural barriers lead to inequitable healthcare access for aboriginal Australians and Torres Strait IslandersHow can collective leadership in fluence the implementation of change in health care?Reasons for failure to continue home therapy in patients with hemophilia:A qualitative study☆

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.