Jnc 8 guidelines hypertension pdf
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Who Do We Look to for Guidance? Geriatric jnc 8 guidelines hypertension pdf as a group of providers are facing an epidemiologic shift.
This change has led to a subtle fragmentation of the overall message from the major societies. KQ 3: How does the patient burden of comorbid conditions modify the benefits of differing BP targets? Compared to hypertensive white persons, 1β4 and γ1γ4 are given in the third column of Table B1. I in the first trimester alone – effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Target an initial SBP below 150 mm Hg, the use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines. Jacobs DR Jr.
Ischemic heart disease, report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Hospital mortality rate for admitted patients dropped as well, lifestyle modifications are generally sufficient for the management of pregnant women with stage 1 hypertension who are at low risk for cardiovascular complications during pregnancy. If the results of the CT scan are inconclusive – blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Producing symptoms which may include confusion, national High Blood Pressure Education Program Working Group.
By the year 2060, people living into their 8th, 9th and 10th decade of life will dominate our patient population. Of those individuals born today in the U. 2014, the authors moved towards a “best available evidence” approach as the gold standard. While this is ultimately seen as beneficial, this change has led to a subtle fragmentation of the overall message from the major societies. Despite these challenges, effective treatment of hypertension is possible using the existing guidelines and a basic knowledge of the principles of targeted geriatric care. Elderly patients, in comparison to younger cohorts, have a higher baseline cardiac risk profile and benefit more than their counterparts from even modest reductions in blood pressure. Making the Diagnosis As reported by JNC 8, the upper limit of normal for SBP is considered to be 140 mm Hg at all ages.
Checking BP in both arms to assess for subclavian stenosis from atherosclerotic vascular disease is imperative, and using the highest value as the real BP is the standard of care. Three different pressure measurements taken on more than two office visits is sufficient, and can reliably predict natural variations in BP. These entities, however, are less prevalent in the elderly. Pseudo-hypertension is more common and should be considered early. Pseudo-hypertension is the result of age-related calcific arteriosclerosis that causes incompressible peripheral arteries. Screening for frailty can also help identify patients at higher risk for these types of adverse clinical outcomes. The degree of frailty can also help guide treatment targets as a higher target may be more appropriate in order to avoid iatrogenic falls, fatigue, or significant disability.
The American Geriatrics Society recommends a criterion-based screening assessment using slow gait speed, poor grip strength, and unexplained weight loss or exhaustion as markers of frailty. Applying Geriatric Principles Is Essential to Everyday Practice Remembering to treat patients conservatively is increasingly important with age. Elderly patients with similar BPs compared to their younger counterparts have a lower baseline cardiac output, higher peripheral resistance, wider pulse pressure, lower intravascular volume, and lower renal blood flow. Before initiating medical therapy, it is important to encourage therapeutic lifestyle changes.
Over time, taste sensitivity is reduced and the elderly often paradoxically increase salt intake, so a recommendation to reduce salt intake should not be forgotten. What Should Be Our Goals When It Comes to Medical Management? Antihypertensive doses should start low, and BP should be lowered gradually. 20 mm Hg above goal should probably be avoided in elderly patients because of an increased risk for hypotension. 60 years old21 Furthermore, beta-blockers are not recommended as initial therapy in the JNC 8 guidelines.