Inpatient setting ideal for improving hypertension regimen

ORLANDO, Fla. — Because BP levels can be more closely monitored in hospitals, they present an ideal setting for changing hypertension regimens when improvement is needed, according to a presentation at Hospital Medicine 2018.

“Hypertension is the number one cardiac risk factor in the world,” Michael Tanner, MD, clinical associate professor at New York University School of Medicine, said during his presentation. “The leading causes of death on our planet are heart attacks at 8 million and strokes at 6 million. Over 1 billion people have high BP. Globally speaking, hypertension is becoming increasingly important.”

New hypertension

Results from the SPRINT trial in 2010 have informed the new guidelines, he said.

In the SPRINT trial, the group with a target of 120 mm Hg had a 27% reduction in all-cause mortality at 3.26 years compared with the group with a target of 140 mm Hg, according to Tanner.

“However, there are differences in opinion,” he said.

The American Diabetes Association’s (ADA) BP target for most patients with diabetes remains 140/90 mm Hg, he said. The ADA’s target is largely based on results from the ACCORD-BP trial in 2010 which found no benefit with a target of 120 mm Hg, he said.

“The American Academy of Family Physicians likewise does not endorse the new ACC/AHA guidelines,” he said.

The AAFP released a statement suggesting that the harms of treating to a lower BP were not assessed in the trial, substantial weight was given to the SPRINT trial while results from other trials were minimized, and intellectual conflicts of interest were not addressed, he said.

“But, there’s good news: The tighter BP target of under 130/80 is an opportunity for us to treat hypertension and comorbid illnesses simultaneously,” Tanner said.

In the new guideline, there are five things that are labeled as harmful or inefficacious, Tanner said.

First, combining an ACE inhibitor with an angiotensin receptor blocker does more harm than good, he said. Being too aggressive in lowering the systolic BP (less than 140 mm Hg within 6 hours of the acute event) for cerebral hemorrhage can be harmful, he said. Pregnant patients should not use ACE inhibitors or angiotensin receptor blockers, he added.

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