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ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Systematic Review

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

David M. Reboussin, Norrina B. Allen, Michael E. Griswold, Eliseo Guallar, Yuling Hong, Daniel T. Lackland, Edgar (Pete) R. Miller, Tamar Polonsky, Angela M. Thompson-Paul, Suma Vupputuri
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https://doi.org/10.1161/HYP.0000000000000067
Hypertension. 2017;HYP.0000000000000067
Originally published November 13, 2017
David M. Reboussin
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Norrina B. Allen
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Michael E. Griswold
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Eliseo Guallar
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Yuling Hong
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Daniel T. Lackland
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Edgar (Pete) R. Miller
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Tamar Polonsky
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Angela M. Thompson-Paul
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Suma Vupputuri
These members of the evidence review committee are listed alphabetically, and all participated equally in the process. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Former Task Force member; current member during the writing effort.
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Abstract

Objective: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy?

Methods: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses.

Results: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome.

  • ACC/AHA Clinical Practice Guidelines
  • Evidence Review Committee
  • meta-analysis
  • blood pressure
  • hypertension
  • home blood pressure monitoring
  • blood pressure
  • targets
  • antihypertensive drug class
  • risk reduction
  • treatment outcomes
  • cardiovascular disease
  • © 2017 by the American College of Cardiology Foundation and the American Heart Association, Inc.
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    Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    David M. Reboussin, Norrina B. Allen, Michael E. Griswold, Eliseo Guallar, Yuling Hong, Daniel T. Lackland, Edgar (Pete) R. Miller, Tamar Polonsky, Angela M. Thompson-Paul and Suma Vupputuri
    Hypertension. 2017;HYP.0000000000000067, originally published November 13, 2017
    https://doi.org/10.1161/HYP.0000000000000067

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    Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
    David M. Reboussin, Norrina B. Allen, Michael E. Griswold, Eliseo Guallar, Yuling Hong, Daniel T. Lackland, Edgar (Pete) R. Miller, Tamar Polonsky, Angela M. Thompson-Paul and Suma Vupputuri
    Hypertension. 2017;HYP.0000000000000067, originally published November 13, 2017
    https://doi.org/10.1161/HYP.0000000000000067
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