Chronic hypertension medical therapy blood pressure goals of treatment
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Deputy Editor-In-Chief Robert G. Badgett, M.D.[2]
The 24-hour ambulatory systolic pressure may better mortality than the daytime systolic blood pressure.
Regarding the accuracy of office oscillometric and home blood pressure monitoring compared with ambulatory blood pressure monitoring, a meta-analysis by the Rational Clinical Examination found:
- Office pressures (presumably attended by medical personnel) has sensitivity and specificity of 51% and 88%
- Home monitoring has sensitivity and specificity of 75% and 76%
Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) levels may help guide treatment.
The decision to treat may be affected by projected longevity of a patient[1]:
- "for patients 60 years and older with hypertension, intensive BP treatment may be appropriate for some adults with a life expectancy of greater than 3 years
- "but may not be suitable for those with less than 1 year."
Clinical practice guidelines
Recommendations for treatment goals from recent clinical practice guidelines are tabulated below. However, treated based on underlying risk rather than a blood pressure target may be more effective. The logic supporting a target of 130/80 mm Hg has been disputed and the Cochrane Collaboration found insufficient evidence to determine a treatment goal for adults or adults over 65 years of age.
If the goal is 130/80, proper measurement includes (distilled from Table 8 of the ACC/AHA guidelines, executive summary):
- having the patient sit quietly for 5 minutes before a reading is taken
- supporting the limb used to measure BP
- ensuring the BP cuff is at heart level
- using the correct cuff size
- for auscultatory readings, deflating the cuff slowly
- the timing of BP measurements in relation to ingestion of the patient’s medication should be standardized
- a single reading is inadequate for clinical decision-making. An average of 2 to 3 BP measurements obtained on 2 to 3 separate occasions will minimize random error and provide a more accurate basis for estimation of BP.
If the above measurement methods are not use, a preliminary study from Kaiser Northern California suggests a target of 140 mm Hg.
| Clinic (routine)
AHA, 2017 |
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- ↑ Chen T, Shao F, Chen K, Wang Y, Wu Z, Wang Y; et al. (2022). "Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension: A Secondary Analysis of Randomized Clinical Trials". JAMA Intern Med. doi:10.1001/jamainternmed.2022.1657. PMID 35532917 Check
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