Blood Pressure Targets  2017.Guidelines For Hypertension 2011-2015.Does SPRINT change our approach to BP targets? SPRINT vs. ACCORD.Updated Hypertension Guidelines Released by ACP, AAFP

1. Magdy El-Masry
Prof. of Cardiology
Tanta University

2. Objectives
Discuss what’s old but still important
Know What's New: Hypertension 2017

3. Blood Pressure Targets
What Do the New Guidelines Say ?
Achieving BP goals in hypertensive patients
The most clinically relevant
measure of BP control.

4. Guidelines For Hypertension 2011-2015
A Flood of Hypertension Guidelines

5. Plethora of HTN guidelines
Oct 2011
Oct 2015
Jun 2013

6. US Hypertension Guideline Mania
Nov 2013
2015 20102012
Dec 2013
Dec 2013
2014

7. On March 31, 2015, the AHA, the ACC, and the ASH issued a new scientific statement
entitled “Treatment of Hypertension in Patients with Coronary Heart Disease.”

8. The multitude of guidelines from respected
professional bodies and individuals have caused,
in my opinion , needless confusion
bordering on chaos.
C. Venkata S. Ram, MD The Journal of Clinical Hypertension Vol 16 | No 4 | April 2014

9. What target BP goals are recommended in
the new guideline?

10. A Flurry of Guidelines for High Blood
Pressure Management
“Flurry of guidelines,
which offer different
recommendations on BP
targets.”

11. *ADA: < 140/80
**KDIGO: <140/90 w/o albuminuria
≤130/80 if >30 mg/24hr
Hypertension Goals of Various Organizations

12. 2015 CHEP

13. Blood pressure targets recommendations in CKD

14. Class/Level of EvidenceConditionBP Goal (mmHg)
IIa/BAge >80 years< 150/90
I/A
IIa/C
IIa/B
CAD
ACS
HF
< 140/90
IIb/C
IIb/C
CAD
Post-MI, stroke, TIA
CAD, PAD, AAA
< 130/80
March 31, 2015

15.  Goals for target BP level or reduction from
pretreatment baseline are uncertain and should be
individualized, but it is reasonable to achieve a
SBP<140 mm Hg and a DBP<90 mm Hg
(Class IIa; Level of Evidence B).
 For patients with a recent lacunar stroke, it might be
reasonable to target a SBP of <130 mm Hg
(Class IIb;Level of Evidence B).

17. 1
1977
2
1980
3
1984
4
1988
5
1993
6
1997
7
2003
8
2014
The Joint National Committee (JNC )

18. The controversial JNC 8
relaxed BP goals from
140/90 to 150/90

19. Blood pressure targets:
are clinical guidelines wrong?
JNC 8 Headlines
Despite Controversy, JNC 8
Guideline Provides Much-
needed Standards for
Hypertension Management
The JNC 8 Hypertension
Guidelines: An In-Depth Guide
A call to retract the JNC-8 hypertension
guidelines
Hypertension Guidelines: Clear as Mud

21. The recent publication of the SPRINT has again
opened the debate on optimal BP targets.
Does SPRINT change our approach to BP targets?

23. SPRINT vs. ACCORD
Which Target Will Win in Diabetes?

25. Outcomes Data from SPRINT and the ACCORD Trial and Combined Data from Both Trials.
In both the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular
Risk in Diabetes (ACCORD) trial, the systolic blood-pressure target in the intensive-treatment group was
less than 120 mm Hg, and the target in the standard-treatment group was less than 140 mm Hg.

26. Know What's New: Hypertension 2017

27. The early release of SPRINT results has not been accompanied by a similar
change in treatment guidelines. The exception is the Canadian Hypertension
Education Program (CHEP) guidelines, which are updated annually

28. The state of CHEP guidelines
pre-SPRINT post-SPRINT
3 Clinical or sub-clinical CVD,CKD (non-diabetic nephropathy, proteinuria <1 g/d, or eGFR
20-59 mL/min/1.73m2),Estimated 10-year global cardiovascular risk >15%.Age ≥ 75 years.
1 Elderly defined as > 80 years age, non-diabetic, with no CKD

30. Hypertension in 2017—What Is the Right Target?
Updated Hypertension Guidelines Released by
ACP, AAFP
(published online January 17 in the Annals of Internal Medicine.)

32. 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
mm Hg to achieve a target systolic blood pressure
of less than 150 mm Hg to reduce the risk for
mortality, stroke, and cardiac events.
(Grade : strong recommendation, high-quality evidence).

33. 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 mm Hg to reduce the risk for recurrent
stroke.
(Grade : weak recommendation, moderate-quality evidence).

34. 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 mm Hg to reduce the
risk for stroke or cardiac events.
(Grade : weak recommendation, low quality evidene).
Clinicians should individually assess cardiovascular risk for patients.
Generally , increased cardiovascular risk includes persons with known vascular disease,
most patients with diabetes , older persons with chronic kidney disease with eGFR less than
45 mL/min/per 1.73 m2, those with metabolic syndrome (abdominal obesity, hypertension,
diabetes, and dyslipidemia),and older persons.