Current guidelines for treating hypertension are conflicting and confusing. Compounding this problem is the fact that not all hypertensive patients are alike. We dont know what blood pressure thresholds create greater risk for patients of different subtypes. And in complex frail patients with multiple comorbidities we suspect but do not know that the treatment of mild hypertension creates risk that outweighs benefit. When should clinicians treat the patient not the numberSpecific questions include1For hypertensive adults at what blood pressure threshold does treatment improve outcomes 2For adults with hypertension treatment to what blood pressure goal improves outcomes3In adults with hypertension what are the comparative benefits and harms of various medicationsdrug classesSubgroups Older adults 65 adults with mild hypertension 1401499099 and with and without a history of cardiovascular disease adults with diabetes mellitus adults with chronic kidney disease adults of different ethnicracial groups African American Native American Asian Hispanic etcOutcomes Stroke MI heart failure end stage renal disease hospitalization CVD related mortality all cause mortality

Hypertension is one of the most prevalent preventable and treatable health conditions in the United States affecting almost 13 of the adult population. It is the most common major risk factor for cardiovascular disease more common than smoking dyslipidemia and diabetes. Risk factors for the development of hypertension include age and obesity so with the aging of our population and the increasing prevalence of obesity it will likely become even more common. Although we have made progress in the identification and treatment of hypertension disagreement and confusion have grown regarding the most effective medications and the treatment goals. The JNC8 stated that there was strong evidence that for adults 60 years of age you should use a treatment threshold of 15090 while others maintain the threshold should be 14090. A Cochrane review showed that treating mild hypertension in adults without cardiovascular disease CVD did not improve morbidity or mortality. Some organizations recommend tighter blood pressure control for patients with diabetes or chronic kidney disease while others do not. In order to guide family physicians we need a thorough unbiased evidence review.

The majority of the current hypertension recommendations come from subspecialty groups. The American Academy of Family Physicians AAFP plans to develop a hypertension guideline for primary care based on evidence and patientcentered outcomes.

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American Academy of Family Physicians

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past nominations involvement with the United States Preventive Services Task Force