In a synopsis of the 2020 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline, published online Sept. 1 in the Annals of Internal Medicine, recommendations are presented for the diagnosis and management of hypertension.
Mark P. Tschanz, D.O., from the Naval Medical Center in San Diego, and colleagues developed guidelines for the diagnosis and management of hypertension in the primary care setting.
The authors recommend periodic screening of adults for elevated blood pressure. Suggested measurement techniques include fully automated office blood pressure measurements, or standard techniques and a properly calibrated and validated sphygmomanometer if fully automated measures are not available. Treatment to a systolic blood pressure goal of <130 mm Hg is suggested for all patients. For patients aged 60 years and older, treatment is recommended to a systolic blood pressure goal of <150 mm Hg with added benefit for further lowering; for patients aged 60 and older with type 2 diabetes, the recommended systolic blood pressure goal is <140 mm Hg, with added benefit for further lowering. For patients aged 30 and older, a diastolic blood pressure goal of <90 mm Hg is recommended. Nonpharmcologic treatment recommendations include losing weight for those with overweight/obesity, exercise, and dietary modifications. Pharmacologic treatment options include a thiazide-type diuretic, calcium-channel blocker, or either an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker as primary therapy for hypertension.
“[This] guideline provides evidence-based recommendations for outpatient evaluation and management of hypertension in adults, with the goal of successful patient-centered management to improve clinical outcomes ” the authors write.