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Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Publication ,  Journal Article
Reboussin, DM; Allen, NB; Griswold, ME; Guallar, E; Hong, Y; Lackland, DT; Miller, EPR; Polonsky, T; Thompson-Paul, AM; Vupputuri, S
Published in: Circulation
October 23, 2018

Objective To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 23, 2018

Volume

138

Issue

17

Start / End Page

e595 / e616

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Practice Guidelines as Topic
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Female
  • Evidence-Based Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Reboussin, David M., Norrina B. Allen, Michael E. Griswold, Eliseo Guallar, Yuling Hong, Daniel T. Lackland, Edgar Pete R. Miller, Tamar Polonsky, Angela M. Thompson-Paul, and Suma Vupputuri. “Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation 138, no. 17 (October 23, 2018): e595–616. https://doi.org/10.1161/CIR.0000000000000601.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 23, 2018

Volume

138

Issue

17

Start / End Page

e595 / e616

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk Factors
  • Practice Guidelines as Topic
  • Middle Aged
  • Male
  • Hypertension
  • Humans
  • Female
  • Evidence-Based Medicine