Expert Consensus Document
ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents Developed in Collaboration With the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension

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Preamble

This document has been developed as an expert consensus document by the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA), in collaboration with the American Academy of Neurology (AAN), the American College of Physicians (ACP), the American Geriatrics Society (AGS), the American Society of Hypertension (ASH), the American Society of Nephrology (ASN), the American Society for Preventive Cardiology (ASPC), the Association of Black Cardiologists (ABC), and

Executive Summary

This document was written with the intent to be a complete reference at the time of publication on the topic of managing hypertension in the elderly. Given the length of the document, the writing committee included this executive summary to provide a quick reference for the busy clinician. Because additional detail is needed, please refer to the sections of interest in the main text. The tables and figures in the document also delineate important considerations on this topic, including the

Family History of Premature Coronary Artery Disease

Premature coronary disease is defined as a first-degree male relative with established CAD at <55 years of age or a first-degree female relative with established CAD at age <65 years.347 Although several studies have shown that the presence of a family history of premature coronary events increases an individual’s risk for CV events anywhere from 2- to 12-fold,348, 349 data on this relationship in older adults are sparse. In the FHS, history of parental premature CAD in persons ≥60 years of age

Measurement of Blood Pressure

BP should be accurately and reliably measured and documented. The diagnosis of hypertension should be based on at least 3 different BP measurements, taken on ≥2 separate office visits to account for the natural variability of BP and other factors that can affect BP. To confirm the validity and reliability of the measurement, at least 2 measurements should be obtained once the patient is comfortable and settled for at least 5 minutes. BP should be measured in the sitting position with the back

Blood Pressure Measurement and Goal

Reliable, calibrated BP measurement equipment is critical for hypertension management in any age group, and these considerations are detailed in Section 3.1. As discussed, the general recommended goal BP in persons with uncomplicated hypertension is <140/90 mm Hg. However, this target for elderly patients with hypertension is based on expert opinion rather than on data from RCTs, and it is unclear whether the target SBP should be the same in 65 to 79 year olds versus older patients.

Quality of Life and Cognitive Function

The decision

Prevention of Hypertension

Most consideration of preventing hypertension has been targeted at young people, and little information is available about preventive strategies in the elderly. Increases in SBP occur with aging in most societies around the world. Unfortunately, there are no clear explanations for these exceptions and thus no clinical guidance.721 It is likely that patterns of decreasing physical activity and weight gain with age in industrialized societies partially explain this trend for increasing SBP with

Staff

American College of Cardiology Foundation

Ralph G. Brindis, MD, MPH, FACC, President

John C. Lewin, MD, Chief Executive Officer

Janet S. Wright, MD, FACC, Senior Vice President, Science and Quality

Charlene May, Senior Director, Science and Clinical Policy

Dawn R. Phoubandith, MSW, Director, ACCF Clinical Documents

Tanja Kharlamova, Associate Director, Science and Clinical Policy

Fareen Pourhamidi, MS, MPH, Senior Specialist, Evidence-Based Medicine

María Velásquez, Specialist, Science and Clinical

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  • Cited by (0)

    Writing Committee Members: W. S. Aronow, J. L. Fleg, C. J. Pepine, N . T. Artinian, G. Bakris, A. S. Brown, K. C. Ferdinand, M. A. Forciea, W. H. Frishman, C. Jaigobin, J. B. Kostis, G. Mancia, S. Oparil, E. Ortiz, E. Reisin, M. W. Rich, D. D. Schocken, M. A. Weber, D. J. Wesley.

    ACCF Task Force Members: R. A. Harrington, E. R. Bates, D. L. Bhatt, C. R. Bridges, M. J. Eisenberg, V. A. Ferrari, J. D. Fisher, T. J. Gardner, F. Gentile, M. F. Gilson, M. A. Hlatky, A. K. Jacobs, S. Kaul, D. J. Moliterno, D. Mukherjee, R. S. Rosenson, J. H. Stein, H. H. Weitz, D. J. Wesley.

    This document was approved by the American College of Cardiology Foundation Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in October 2010 and the governing bodies of the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension in March 2011. For the purpose of complete transparency, disclosure information for the ACCF Board of Trustees, the board of the convening organization of this document, is available at: http://www.cardiosource.org/ACC/About-ACC/Leadership/Officers-and-Trustees.aspx.

    ACCF board members with relevant relationships with industry to the document may review and comment on the document but may not vote on approval.

    The American College of Cardiology Foundation requests that this document be cited as follows: Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Forciea MA, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2011;57:2037–114.

    This article is reprinted with permission from the American College of Cardiology Foundation and the American Heart Association, Inc.

    This article has been copublished in Circulation, the Journal of Clinical Hypertension, the Journal of Geriatric Cardiology, and originally appeared in the Journal of the American College of Cardiology.

    Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.cardiosource.org), the American Heart Association (my.americanheart.org). For copies of this document, please contact Elsevier Inc. Reprint Department, fax 212-633-3820, e-mail [email protected].

    Permissions: Modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American College of Cardiology Foundation.

    Authors with no symbol by their name were included to provide additional content expertise apart from organizational representation.

    a

    American College of Cardiology Foundation Representative

    b

    National Heart, Lung, and Blood Institute

    c

    American Heart Association Representative

    d

    Association of Black Cardiologists Representative

    e

    American College of Physicians Representative

    f

    American Academy of Neurology Representative

    g

    European Society of Hypertension Representative

    h

    American Society of Nephrology Representative

    i

    American Geriatrics Society Representative

    j

    American Society for Preventive Cardiology Representative

    k

    American Society of Hypertension Representative

    l

    ACCF Task Force on Clinical Expert Consensus Documents Representative

    m

    Former Task Force member during this writing effort

    Authors with † symbol by their name were included to provide additional content expertise apart from organizational representation.

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