» Back to list of all Management eBriefs
|Issue 113||July 2016|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Systematic Review: Benefits and Harms of Treating Blood Pressure in Older Adults
Hypertension is a very common chronic illness in the United States and among Veterans. Use of antihypertensive medications can lower the risk of cardiovascular disease, cerebrovascular disease, renal disease, and death. However, the most beneficial blood pressure targets for patients of specific age groups has been a topic of some debate, stemming from concerns that the ratio of benefit to harm of a given blood pressure level may vary with age. In 2014, the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure published new guidelines for the treatment of hypertension, as well as a new treatment goal for older individuals (over age 60) for systolic blood pressure (SBP) of <150 mm Hg rather than <140 mm Hg. The new goal for those over 60 years of age has been very controversial, and has been debated among experts with viewpoints supporting both higher and lower treatment goals.
Conducted by investigators with the VA Evidence-Based Synthesis Program (ESP) in Portland, Oregon, this systematic review examined the current literature in order to examine the benefits and harms of differing blood pressure targets among adults over age 60. ESP investigators reviewed the literature from inception through December 2015. After reviewing more than 10,600 titles and abstracts, they identified 21 randomized controlled trials (RCTs) and 3 cohort studies that fit their review criteria. Findings from this systematic review show:
Findings also indicate that lower treatment targets are associated with higher medication burden and an increased risk of short-term harms such as hypotension. On the other hand, evidence that there is not an increase in longer-term harms such as cognitive impairment, falls, and reduced quality of life, may provide some flexibility for providers attempting to weigh the risks and benefits of more antihypertensive therapy in crafting an individualized treatment plan. There was little data to assess the balance of risks and benefits of antihypertensive treatment among the frail elderly.
A Cyberseminar session on this ESP Report will be held on Wednesday, October 5, 2016 from 2:00pm to 3:00pm (ET). To register, go to the HSR&D Cyberseminar web page.
(copy and paste if you have VA intranet access)
Please feel free to forward this information to others!
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
See all reports online.