Issue #71 Blood pressure targets for hypertension in older adults Clinical Case and Discussion Questions Created by William E Cayley, Jr Journal Club Editor Prevea Family Medicine Residency

Fred Fred is a 65-year-old man who has been seeing you for primary care for the past 20 years. He does not smoke, he is physically active and exercises regularly, and his only medication is a thiazide diuretic for high blood pressure. He has always taken an active interest in staying up-to-date on the latest health news and medical recommendations.

Fred Fred comes to see you today concerned about the adequacy of his blood pressure management. Most of his systolic blood pressure readings for the past 3 years in the office have been between 140 and 145 mmHg. However, he has recently read of newer guidelines recommending lower targets for blood pressure control. Today, he asks you what you think is the most scientifically appropriate goal for his blood pressure.

Fred You discuss with him that recent guidelines have produced varying conclusions and recommendations, and he asks you what the best evidence would support. In effort to find the best current evidence on blood pressure targets for older patients, you search the Cochrane Library and find a review entitled: Blood pressure targets for hypertension in older adults

Questions for discussion How would you summarize the findings of this review? How would you describe the strengths and weaknesses of this evidence base? How do the conclusions of this review corroborate or challenge the recommendations of recent hypertension guidelines? (See next slide) Based on both recent blood pressure guidelines and the conclusions of this review, what would you recommend to Fred and why?

Recent blood pressure guidelines ACC/AHA guideline for high blood pressure in adults. https://www.ncbi.nlm.nih.gov/pubmed/29133356 Hypertension Canada's 2017 guidelines for hypertension in adults. https://www.ncbi.nlm.nih.gov/pubmed/28449828 Treatment of hypertension in adults aged 60 years or older: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. https://www.ncbi.nlm.nih.gov/pubmed/28135725 2014 evidence-based guideline for the management of high blood pressure in adults. https://www.ncbi.nlm.nih.gov/pubmed/24352797 Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 2000 Jul 19;284(3):357-62. PubMed PMID: 10891968. https://jamanetwork.com/journals/jama/fullarticle/192895 Giacomini MK, Cook DJ. Users' guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA. 2000 Jul 26;284(4):478-82. PubMed PMID: 10904512. https://jamanetwork.com/journals/jama/fullarticle/192915

Further information How to cite the Cochrane Review: Garrison SR, Kolber MR, Korownyk CS, McCracken RK, Heran BS, Allan GM. Blood pressure targets for hypertension in older adults. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD011575. DOI: 10.1002/14651858.CD011575.pub2. Find out more about Cochrane Journal Club: http://www.cochranelibrary.com/more-resources/cochrane-journal-club-.html Share your thoughts about this Journal Club: Email: CochraneJournalClub@wiley.com This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.