High Blood Pressure In Adults Research Articles

The 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Resource for Practicing Clinicians.

The 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults is the first comprehensive clinical practice guideline for hypertension since t...

Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline.

In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The committee reviewed literature and commissioned systematic reviews and meta-analyses on out-of-office BP monitoring, the optimal target for BP lowering, the comparative benefits and harms of different classes of antihypertensive agents, and the comparative benefits and harms of initiating therapy with a single antihypertensive agent or a combination of 2 agents. This article summarizes key recommendations in the following areas: BP classification, BP measurement, screening for secondary hypertension, nonpharmacologic therapy, BP thresholds and cardiac risk estimation to guide drug treatment, treatment goals (general and for patients with diabetes mellitus, chronic kidney disease, and advanced age), choice of initial drug therapy, resistant hypertension, and strategies to improve hypertension control.

Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals. This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among US adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9 623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce US population estimates. According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among US adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of US adults, respectively. Nonpharmacological intervention is advised for the 9.4% of US adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among US adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of US adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication.

Prevalence of Hypertension And Its Correlates Among School Girls In Bengaluru

Background Tracking of blood pressure in childhood has been reported to be advantageous in that it will help in control and possibly the prevention of high blood pressure in adulthood before its harmful sequelae can occur. Due to paucity of literature on hypertension among girls this exploratory study was envisaged.Objectives To estimate the prevalence of hypertension and its correlates in urban school girls aged 6-15 years.Methodology A cross sectional study was undertaken in the selected urban girlsrsquo school in Bengaluru from February to March 2016. Socio-demographic information anthropometric measurements which included weight and height were collected. Percentiles of measurements were calculated as per Revised Indian Academy of Paediatrics 2015 growth charts. Blood pressure was measured and classified as recommended by the Fourth Report on the diagnosis evaluation and treatment of high blood pressure in children and adolescents. The students were considered hypertensive if the systolic or diastolic blood pressure or both were equal to or more than the 95th percentile for height for age and sex amp pre-hypertensive if the same was between 90th to 94thpercentiles. Children who were found to have hypertension were advised to go for follow up with a paediatrician for further management.Results Among a total of 905 girls examined the prevalence of hypertension between the ages of 6 ndash 15yrs was 15.5 n140 95 CI 13.09 ndash 17.50 and pre-hypertension was 7.7 n70 95 CI 5.92 ndash 9.47. Blood pressure was significantly higher among those with higher BMI overweight amp obese P lt0.001 and was an independent predictor as revealed through logistic regression analysis.Conclusion Pre-hypertension and hypertension is a substantial problem among school girls. A programme to screen school girls for early diagnosis of hypertension and lifestyle education would be useful to prevent future complications of hypertension. Health promotion through school health programmes would pre-empt the problem.

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.

Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline

BackgroundThe 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals. ObjectivesThis study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). MethodsThe authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates. ResultsAccording to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. ConclusionsCompared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication.

Blood pressure in young adulthood and residential greenness in the early-life environment of twins

BackgroundPrevious research shows that, besides risk factors in adult life, the early-life environment can influence blood pressure and hypertension in adults. However, the effects of residential traffic exposure and residential greenness in the early-life on blood pressure in young adulthood are currently unknown.MethodsAmbulatory (24-h) blood pressures of 278 twins (132 pairs) of the East Flanders Prospective Twins Study were obtained at the age of 18 to 25 years. Prenatal and adulthood residential addresses were geocoded and used to assign prenatal and postnatal traffic and greenness indicators. Mixed modelling was performed to investigate blood pressure in association with greenness while adjusting for potential confounding factors.ResultsNight-time systolic blood pressure was inversely associated with greenness at the residential address in twins living at the same address their entire life (non-movers, n = 97, 34.9%). An interquartile increase in residential greenness exposure (1000 m radius) was associated with a 3.59 mmHg (95% CI: -6.0 to −1.23; p = 0.005) lower adult night systolic blood pressure. Among twins who were living at a different address than their birth address at time of the measurement (n = 181, 65.1%), night-time blood pressure was inversely associated with residential surrounding greenness at adult age as well as with residential greenness in early-life. However after additional adjustment for residential greenness exposure in adulthood, only residential greenness exposure in early-life was significantly associated with night systolic blood pressure. While no significant effect of adult residential greenness with adult blood pressure was observed, while accounting for the early-life greenness exposure.ConclusionsLower residential greenness in the early-life environment was independently associated with a higher adult blood pressure. This indicates that residential greenness has persistent effects on blood pressure.

Associated Factors and Standard Percentiles of Blood Pressure among the Adolescents of Jahrom City of Iran, 2014

Background. High blood pressure in adults is directly correlated with increased risk of cardiovascular diseases. Hypertension in childhood and adolescence could be considered among the major causes of this problem in adults. This study aimed to investigate the factors associated with hypertension among the adolescents of Jahrom city in Iran and also standard percentiles of blood pressure were estimated for this group. Methods. In this community-based cross-sectional study 983 high school students from different areas of the city were included using a multistage random cluster sampling method in 2014. Blood pressure, weight, and height of each student measured using standard methods. Data were analyzed by statistical software SPSS 16. Results. In total, 498 male and 454 female students were included in this study. Average systolic blood pressure of students was 110.27 mmHg with a variation range of 80.6–151.3. Average diastolic blood pressure was 71.76 mmHg with the variation range of 49.3–105. Results of this study indicated that there was a significant relationship between gender, body mass index, and parental education level with systolic and diastolic blood pressure of the students (P < 0.05). Conclusions. Body mass index was one of the most important changeable factors associated with blood pressure in adolescents. Paying attention to this factor in adolescence could be effective in prevention of cardiovascular diseases in adulthood.

Association between maternal education and blood pressure: mediation evidence through height components in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background: Maternal education influences skeletal growth and offspring adult blood pressure (BP). Height components are negatively associated with BP in high-income countries.Aim: To evaluate the association between maternal education and offspring adult systolic and diastolic BP (SBP/DBP), assessing whether different height components might mediate such an association.Subjects and methods: Simple mediation modelling was used to evaluate the maternal education-offspring SBP/DBP association, estimating the contribution of offspring height components, in a cross-sectional sample of 13 571 Brazilians aged 34–75 from the ELSA-Brasil study.Results: After full adjustment for confounders, and compared to participants whose mothers received low education, those whose mothers received high education had, on average, 0.2 mm Hg lower SBP (95% CI = −0.274, −0.132), as result of the link between maternal education and offspring adult height which, in turn, influenced SBP. Thus, 18–26% of the maternal education-SBP association occurred indirectly, through height, trunk and leg length, alternatively.Conclusions: Better maternal education might influence higher leg and trunk lengths in offspring, which, in turn, might contribute to prevent higher BP in adults. The negative height-BP association reported in high-income countries is also present in a middle-income country with more recent economic development.

Is 60 the New 80 in Hypertension?

Since the release of the "2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)", much controversy has ensued over the appropriate systolic blood pressure goal for those over the age of 60years. This guideline suggested liberalizing the target for this population to <150mmHg, moving away from previous guidelines suggesting a target of <140mmHg. While some national quality measures have accepted the new relaxed blood pressure goal, the American Heart Association and American College of Cardiology have not. Recently published data show that millions of adults over 60years of age would be classified as controlled using a threshold of <150mmHg, but not with a target of <140mmHg. In addition, emerging randomized trial evidence suggests that targeting a systolic blood pressure well below 140mmHg is beneficial in older adults. In light of the improved health and vitality of older adults, and the steady decline in cardiovascular and cerebrovascular mortality over recent decades, we do not think it is in good judgment to liberalize the treatment target in adults less than 80 years of age.

Abstract P179: Systolic Blood Pressure and Risk for Cardiovascular Disease Among Adults 60 Years and Older without Diabetes or Chronic Kidney Disease

The 2014 Evidence-based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) raised the systolic blood pressure (SBP) threshold for treatment initiation and goal attainment to 150 mmHg in adults 60 years and older without a history of diabetes or chronic kidney disease (CKD). Using data from the nationwide Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, we examined the association between SBP levels and cardiovascular disease (CVD), coronary heart disease (CHD), and stroke among adults ≥60 years of age. We excluded participants with a history of diabetes, CKD, and diastolic blood pressure (DBP) ≥90 mmHg. Baseline REGARDS data were collected during telephone interviews and in-home study visits in 2003 through 2007 and included two blood pressure measurements following a standardized protocol. SBP was categorized as &lt;140 mmHg, 140-149 mmHg, and ≥150 mmHg. Outcomes were identified through December 31, 2012 using primary data collection. Of the 4,618 REGARDS participants taking antihypertensive medication, 593 (12.8%) had SBP 140-149 mmHg and 343 (7.4%) had SBP ≥150 mmHg. After multivariable adjustment, SBP of 140-149 mmHg versus SBP &lt;140 mmHg was not associated with any of the outcomes (Table 1) whereas SBP ≥150 mmHg was associated with an increased risk for CVD and CHD, but not stroke. Of the 5,601 participants not taking antihypertensive medication, 417 (7.5%) had SBP 140-149 mmHg and 181 (3.2%) had SBP ≥150 mmHg. Compared with SBP &lt;140 mmHg, SBP140-149 mmHg but not SBP ≥150 mmHg was associated with an increased risk for CVD, CHD, and stroke. In summary, SBP between 140-149 mmHg was associated with CVD-related outcomes in untreated, but not treated individuals. These data suggest using different thresholds for antihypertensive treatment initiation and goal attainment among individuals ≥60 years of age without a history of diabetes or CKD, with DBP ≥90 mmHg may be safe.

The problem of reproductive health from the perspective of perinatology

The federal reporting forms over 1986–1995 and the official statistics over 2009–2014 were analyzed using the methods of descriptive statistics and correlation analysis to identify the relationship of neonatal health status to reproductive problems in adulthood. The investigation showed that at the end of the 20th century, the overall structure of newborns showed a larger proportion of very low (1000–1499 g) and low (1500–2499 g) birth weight babies from 0,42% in 1986 to 0,47% in 1995 and from 4,9 to 5,46%, respectively. Moreover, the common neonatal abnormalities were birth trauma, intrauterine hypoxia, birth asphyxia, congenital abnormalities, growth retardation, and malnutrition. Further, there was a decline in the number of people coming of active reproductive age, men and women alike (24,77% in 2009 and 23,77% in 2014). With this, in 2009–2014, the adult population exhibited increases in the incidence of newly diagnosed cases of diseases of the endocrine, circulatory, and urinary systems (by 6,61, 15,07, and 4,14%, respectively), and female infertility (by 21,25%). Correlation analysis indicated that there was a negative relationship between neonatal hemolytic disease and adult-onset circulatory diseases and anemia (r =–0,45; p<0,05 and r =–0,48; p<0,05); infections specific to the perinatal period, salpingitis and oophoritis (r =–0,30; p<0,05); there was a direct correlation between congenital pneumonia in the newborn and diabetes mellitus, diseases characterized by high blood pressure in adults (r =0,31; p<0,05 and r =0,36; p<0,05); respiratory distress syndrome and insulin-dependent diabetes mellitus (r =0,38; p<0,05). Pathological processes result in a vicious circle: a neonatal patient — a female and/or male patient — pregnancy and/or labor pathology — a sick child.

Factores asociados y descripción general de infección del tracto urinario en niños

La infección del tracto urinario (ITU) es una patología frecuente en la infancia, reconocida como precipitante de enfermedades agudas y crónicas con un gran índice de morbilidad. Es importante el diagnóstico apropiado para minimizar la instauración de cicatrices renales, falla renal e hipertensión arterial en la edad adulta. Las indicaciones de profilaxis han cambiado en los últimos años. Objetivo: Dar a conocer los conocimientos actuales en patogénesis diagnóstico y manejo posterior en ITU. Metodología: Se realizó una revisión bibliográ- fica entre los años 1995 al 2016, en las bases de datos de Scielo, Elsevier, Pubmed, Redalyc, ScienceDirect, Medwave, Nature Reviews, EBSCO, Naxos, Bases de datos que ofrece la Universidad del Cauca. Se utilizó los términos MeSH y DeSC -“Urinary Tract Infectión, Risk factor, children, diagnostic, treatment”, en inglés y español con un total de 276 documentos. Posteriormente fueron evaluados con los respectivos instrumentos de lectura crítica de artículos así: Consort para ensayos clínicos, Strobe, para estudios observacionales, Prisma para meta-análisis y Agree para guía de práctica clínica, filtrando un total de 58 documentos. Para la gestión de la información se utilizó el programa Mendeley de libre acceso. Resultados: Los conocimientos en ITU en pediatría han avanzado más hacia la prevención de cicatrices y prevención de enfermedades en la etapa adulta. Las indicaciones de profilaxis han cambiado y son más escuetas. Conclusiones: La ITU es frecuente en pediatría. Han cambiado los manejos, por ahora se necesitan más estudios en nuestra población.

Lower blood pressure targets: to whom do they apply?

For many decades, the optimum blood pressure treatment target to prevent cardiovascular disease has been debated. Until 2013, most guidelines suggested that the general population with hypertension should be treated to achieve a blood pressure goal of lower than 140/90 mm Hg, but that the goal for some high-risk groups, such as patients with diabetes and chronic kidney disease, should be a blood pressure of lower than 130/80 mm Hg. In 2013, most guidelines relaxed the recommendations for high-risk patients, based on a lack of evidence, which was brought to attention after the disappointing results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. 1 Mancia G Fagard R Narkiewicz K et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31: 1281-1357 Crossref PubMed Scopus (4059) Google Scholar , 2 James PA Oparil S Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA. 2014; 311: 507-520 Crossref PubMed Scopus (5873) Google Scholar , 3 Cushman WC Evans GW Byington RP et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362: 1575-1585 Crossref PubMed Scopus (2746) Google Scholar Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysisIntensive blood pressure lowering provided greater vascular protection than standard regimens. In high-risk patients, there are additional benefits from more intensive blood pressure lowering, including for those with systolic blood pressure below 140 mmHg. The net absolute benefits of intensive blood pressure lowering in high-risk individuals are large. Full-Text PDF

Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.

Update of the 2007 U.S. Preventive Services Task Force (USPSTF) reaffirmation recommendation statement on screening for high blood pressure in adults. The USPSTF reviewed the evidence on the diagnostic accuracy of different methods for confirming a diagnosis of hypertension after initial screening and the optimal rescreening interval for diagnosing hypertension. This recommendation applies to adults aged 18 years or older without known hypertension. The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. (A recommendation) The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.

Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement.

Implications of the Eighth Joint National Committee Guidelines for the Management of High Blood Pressure for Aging Adults: Atherosclerosis Risk in Communities Study.

The recent 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults from the Eight Joint National Committee Panel may significantly affect the aging US population. We performed a cross-sectional analysis of black and white participants in Atherosclerosis Risk in Communities who participated in the fifth study visit (2011-2013). Sitting blood pressure was calculated from the average of 3 successive readings taken after a 5-minute rest. Currently, prescribed antihypertensive medications were recorded by reviewing medication containers brought to the visit. Blood pressure control was defined using both the Seventh and Eighth Joint National Committee thresholds. Of 6088 participants (mean age, 75.6 [range, 66-90] years, 58.4% women; 23.2% black), 54.9% had either diabetes mellitus or chronic kidney disease. The prevalence of hypertension according to Seventh Joint National Committee thresholds was 81.9%, and 62.8% of the entire sample were at blood pressure goal. Using the Eighth Joint National Committee thresholds, 79.4% were at blood pressure goal (16.6% were reclassified as at-goal). Reclassification was higher for individuals with diabetes mellitus or chronic kidney disease (20.6%) when compared with individuals without either condition (11.6%). The use of antihypertensive medications in our cohort was high, with 75.0% prescribed at least 1 antihypertensive medication and 46.7% on ≥2 antihypertensive agents. In conclusion, in a US cohort of aging white and black individuals, ≈1 in 6 individuals were reclassified as having blood pressure at goal by Eighth Joint National Committee guidelines. Despite these less aggressive goals, >20% remain uncontrolled by the new criteria.

A review of the JNC 8 Blood Pressure Guideline.

Hypertension is a major independent risk factor for coronary artery disease, stroke, heart failure, and renal failure. One of every 3 American adults—or approximately 67 million adults (31%)—has hypertension (HTN).1 A person over the age of 55 years has a 90% lifetime risk of developing HTN.2 Hypertension accounts for 18% of cardiovascular disease deaths in Western countries.3 High blood pressure (BP) costs the nation $47.5 billion each year.4 In 2014, the Eighth Joint National Committee (JNC 8) published the evidence-based guideline for the management of high BP in adults. This new guideline was characterized by a systematic review of the literature with an emphasis on randomized, controlled clinical trials. The guideline attempted to answer 3 key questions.5 In adults with HTN, does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? In adults with HTN, do attempts to reach specified BP goals with antihypertensive pharmacologic therapy lead to improvements in health outcomes? In adults with HTN, do various antihypertensive drugs or drug classes differ in regard to specific health outcomes?5 The committee provided 9 graded recommendations to answer the 3 key questions. Grading was performed on the basis of the strength of the available evidence used to make the recommendation: grade A is indicative of strong evidence, grade B of moderate evidence, grade C of weak evidence, and grade E of expert opinion (in lieu of sufficient evidence). Below are the 9 recommendations.5 Recommendation 1. The guideline recommends the initiation of drug therapy in order to lower a systolic BP (SBP) of ≥150 mmHg or a diastolic BP (DBP) of ≥90 mmHg for the general population at 60 years of age or older (Grade A). A corollary recommendation is that patients whose achieved SBP on pharmacologic therapy is lower than the new guideline recommendation can be continued at that level of therapy, if well tolerated (Grade E). Recommendation 2. The target DBP to start pharmacologic therapy for subjects younger than 60 years of age is ≥90 mmHg. On the basis of available evidence, the recommendation for patients aged 30 to 59 years is strong (Grade A). For those between the ages of 18 and 29, the recommendation is on the basis of expert opinion (Grade E). Recommendation 3. The target SBP to start pharmacologic therapy for subjects younger than 60 years of age is ≥140 mmHg (Grade E). Recommendation 4. In the population aged 18 years or older with chronic kidney disease, initiate pharmacologic treatment to lower BP at SBP ≥140 mmHg or DBP ≥90 mmHg and treat to a goal of SBP <140mmHg and a goal of DBP <90 mmHg (Grade E). Recommendation 5. The target blood pressure in beginning pharmacologic therapy for the diabetic population aged 18 years or older is <140 mmHg for SBP and <90 mmHg DBP (Grade E). Recommendation 6. Initial drug therapy for nonblack patients (including diabetic patients) should include a thiazide-type diuretic, a calcium channel blocker, an angiotensin-converting enzyme (ACE) inhibitor, or an angiotensin receptor blocker (Grade B). Recommendation 7. Initial drug therapy for black patients should include a thiazide-type diuretic or a calcium channel blocker. This includes patients with diabetes mellitus (Grade B; for diabetic black patients, Grade C). Recommendation 8. For patients 18 years and older with chronic kidney disease, initial or additional therapy should include an ACE inhibitor or angiotensin receptor blocker, regardless of race or diabetic status (Grade B). Recommendation 9. An algorithm for managing patients who do not achieve control within one month is recommended. If the goal is not achieved, increase the dose of the initial drug or add a 2nd drug from one of the classes in recommendation 6. A 3rd drug should be added if the goal is not achieved with 2 drugs. Drugs from other classes can be used if the target is not achieved with the recommended classes, or if there is a contraindication to one of the recommended drug classes. ACE inhibitors should not be combined with angiotensin receptor blockers in the same patient. Referral to an HTN specialist should be considered in complicated cases or in the event of inability to control BP (Grade E).5

In‐home Food Supply among Elderly Home‐Delivered Meal Recipients with High Blood Pressure or Diabetes

INTRODUCTIONThe U.S. 2011‐2012 prevalence of diabetes and high blood pressure in adults &gt;60 was 21% and 67% respectively. This study examined 2 subsets of 2010 – 2013 MOW recipients in 5 states, who were &gt;60 years and lived alone: with self‐reported current diagnosis of HBP and with self‐reported current diagnosis of diabetes and associated the results with the sodium and sugar content of their in‐home food supply.METHODSDuring home‐visits, data collectors interviewed study participants re their current health status and inventoried their in‐home food supplies.RESULTSThe 719 participants in this study were 66% female; 68% White, 28% Black, and on average, 79.9±9.5 years old. Three‐quarters had 5 meals delivered/week by MOW.Most of the in‐home food supply calories (71%) were from dry shelf‐stable foods, indicating a preponderance of processed food. A current diagnosis of HBP and of diabetes were reported by 65% and 34% of participants. The nutrient adequacy ratio (NAR) for sodium (100% daily value (DV)/2,000 calories = 2,400 mg/day) was 1.56, and for sugar (100% DV/ 2,000 calories = 50 g/day(proxy)) was 2.03 indicating the sodium and sugar content of their in‐home food supply was, on average, 56% and 103% higher than recommended.CONCLUSIONThe levels of sugar and sodium in food supplies of participants diagnosed with hypertension and diabetes are not congruent with current recommendations and increase the risk of other chronic conditions. The excess sodium and sugar in the in‐home food supplies of elderly individuals with HBP and diabetes represents a preventable health risk to be addressed via nutrition and health communication programs.

Screening for High Blood Pressure in Adults During Ambulatory Nonprimary Care Visits: Opportunities to Improve Hypertension Recognition.

Visits with nonprimary care providers such as optometrists may be missed opportunities for the detection of high blood pressure (BP). For this study, normotensive adults with at least 12 months of health plan membership on January 1, 2009 (n=1,075,522) were followed-up for high BP through March 14, 2011. Of 111,996 patients with a BP measurement ≥140/90 mm Hg, 82.7% were measured during primary care visits and 17.3% during nonprimary care visits. Individuals with a BP ≥140/90 mm Hg measured during nonprimary care visits were older and more likely to be male and non-Hispanic white. The proportion of patients with follow-up and false-positives were comparable between primary and nonprimary care. The main nonprimary care specialty to identify a first BP ≥140/90 mm Hg was ophthalmology/optometry with 24.5% of all patients. Results suggest that expanding screening for hypertension to nonprimary care settings may improve the detection of hypertension.