Samuel Cykert, MD; Principal Investigator, North Carolina Cooperative
The new hypertension guideline from the American College of Cardiology and the American Hospital Association is important for practices working to improve cardiovascular preventive services, but some of the recommendations have been controversial. I have been talking to many of our enrolled practices in EvidenceNOW about these guidelines. Practices are enthusiastic about the non-pharmacologic interventions and the specific pharmacotherapy recommendations, but they are reluctant to push for more medicines to lower pressures below 130/80, given the lack of evidence for lower diastolic pressures and their fear of side effects in the elderly. They also wonder how the recommendation for diabetic patients fits given the lack of efficacy of tight control for this group demonstrated in the ACCORD Trial. Through my work with EvidenceNOW, I hope to push for a more systematic approach to non-pharmacologic treatment of hypertension and devise approaches to measure success. Given the surrounding controversies, we will limit advocating more medical therapy for the aggressive 130/80 target to those patients with documented high risk.