Under Pressure: Interpretation of hypertension guidelines ...

[Pages:47]OGS Under Pressure:

Interpretation of hypertension guidelines and data to individualize care for older adults

Oregon Geriatrics Society Meeting 2020

2020 Jessica Weiss, MD MCR

OGS 2020

OGS Objectives

? Review the differences between current hypertension guidelines

? Evaluate the role that chronic kidney disease and complex comorbidity play in defining blood

2020 pressure targets

? Assess the role for specific medications to manage hypertension in older adults.

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Treatment of hypertension improves

OGS cardiovascular outcomes MRC Mean Age 51

2020 Aus-BP Mean Age 50.5

VA Cooperative Studies

VA Cooperative Studies, JAMA, 1967 & 1970

Mean Age 50-52

Aus-BP, Lancet, 1980 MRC, BMJ, 1985

OGS 2020

In adults, some blood pressure control is better than none to decrease cardiovascular events & death.

Dr. A

You say my blood pressure

OGS An 83 yo retired PhD, referred by his primary care provider

for recommendations on hypertension management.

PMH: Hypertension Diet-controlled DM

Edema (multifactorial) BPH

should be lower ? how much lower? I read the news ? no one agrees!

PUD

Gout

188/66 169/59 HR 62

2020 Medications:

Amlodipine 2.5 mg/d Atenolol 50 mg daily Lasix 20 mg daily Tamsulosin 0.4 mg/d

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Recent practice guidelines don't agree

on blood pressure targets for older

OGS JNC-8

ACP/

adults.

2020 AAFP

ACC/ AHA

Guideline JNC-8 2014

ACP/AAFP 2016

ACC/AHA 2017

BP target recommendation/rationale

-In a population of patients age 60 and older, initiate

OGS therapy with SBP >150 or DBP >90 and treat to target

150 and treat to ................
................

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