51成人动漫

This article is a collaboration between 51成人动漫 and:

CHICAGO -- Guidelines for hypertension treatment issued a year ago classify as "on-target" many older adults who wouldn't be at goal by other standards and are at elevated risk for events, a study showed.

When the hypertension treatment recommendations from panel members appointed to the Eighth Joint National Committee (commonly but unofficially known as JNC 8) controversially shifted the blood pressure treatment goal from 140/90 mm Hg to 150/90 mm Hg for patients ages 60 and older without diabetes or chronic kidney disease, it reclassified one in seven people seen at cardiology clinics for hypertension into being "at goal."

However, among those 14.6%, nearly a quarter had a prior stroke or transient ischemic attack, and 65% had coronary artery disease, found , of George Washington University, Washington, D.C., and colleagues.

Their average Framingham risk score was 8.5% and 10-year atherosclerotic cardiovascular disease risk score averaged 28.0%, according to the group's analysis of the National Cardiovascular Data Registry (NCDR) PINNACLE registry.

Sticking with the lower goal -- as still recommended by the American College of Cardiology, American Heart Association, and other groups -- could potentially prevent 8,000 cardiovascular events nationally over 10 years in the 60-and-older study population, they projected.

The findings were reported here at the American Heart Association meeting and online in the.

"If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring, since many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk," Borden's group wrote.

In an accompanying editorial, , of Mount Sinai Heart in New York City, seconded that call.

"This is the unintended consequence of what is otherwise a thoughtful and useful set of recommendations from some members of the JNC 8 Writing Committee for the management of hypertension," he wrote. "We do not know how practice patterns will change based on the JNC 8 panel recommendations, but it will be important to monitor these patterns, to follow blood pressure control on a population basis, especially in those patients older than 60 years and those with diabetes, and to follow any consequent changes in cardiovascular morbidity and mortality in these very large and growing segments of the population."

He cited suggesting that 13.5 million patients with hypertension eligible for treatment under the 2003 JNC 7 guidelines would not be treated under the new one, which he noted "contradicts the avalanche of (contemporary) hypertension guidelines."

"We were very concerned when the new recommendations were published that went outside of the usual guideline methods that we had adopted," said ACC president-elect , of Rush University in Chicago.

"Our official position has been that until we have had an opportunity to review the entire area [in the literature], that we would continue along with the recommendation of the NHLBI to use the JNC 7 recommendations," he told 51成人动漫.

That guideline review process with the AHA and other groups is ongoing, likely through the next year or so, he said.

However, Williams said that the cautionary note sounded by the study authors was only hypothesis-generating. "We will find out if over time whether that [change in goal] results in a substantial number of people having more of the complications of hypertension, including heart failure, kidney failure, and stroke."

The study included data on 1.2 million patients collected between 2008 and 2012 from the NCDR Practice Innovation and Clinical Excellence (PINNACLE) Registry, which collects continuous, real-time clinical information on all patients treated in participating U.S. outpatient cardiology practices.

Another look at the registry showed vast room for improvement in statin use to fit the 2013 ACC/AHA cholesterol guidelines.

Whereas 96% of that selected population being seen at cardiology practices was statin-eligible by the guidelines, 32% were not on a statin and 23% were getting nonstatin lipid lowering therapies, , of the VA Eastern Colorado Health Care System, Denver, and colleagues, reported at the AHA conference and online in JACC.

Even in the elevated 10-year risk group, 36% weren't getting a statin. But more than 20% were getting repeat LDL testing not called for by the updated cholesterol guidelines.

"If the 377,311 eligible patients in the PINNACLE population not currently receiving statin therapy receive them as a result of these guideline changes, then those patients would have a 25% reduction, on average, in cardiovascular events," the researchers wrote.