10 Questions on Adult Blood Pressure Targets Based on AAFP Guidelines
The American Association of Family Physicians’ 2022 clinical practice guideline on blood pressure (BP) targets in adults with hypertension recommends a ceiling target to reduce the risk of all cause and cardiovascular mortality, and a separate target to reduce likelihood of myocardial infarction in those with that risk.
Distinctions between the 2 recommended targets and the supporting evidence, as well as the guidance from the AAFP on making treatment decisions and on attaining and maintaining target blood pressure levels are the topics of the following 10 questions.
Recommended blood pressure targets differ between recent guidelines. Match the guideline source for the respective recommended blood pressure level targets for adults 18-59 years of age.
Note: A target of < 50/90 was previously recommended for adults 60 years of age and older by the AAFP in its 2017 guideline (with the American College of Physicians) and is recommended for that age group in the 2020 DVA guideline.
2. Per the AAFP, which statement/s correspond/s to targeting lower than the recommended blood pressure level target for adults with hypertension?
Answer: E. Treating to a lower blood pressure target (<135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values.
3. The AAFP recommends that shared decision-making, which considers patient preferences and goals when establishing a blood pressure target level, include which of the above?
Answer: D. All the above. Patient risk for CVD should be incorporated into shared decision-making, and treatment options should include risk-reduction measures.
4. Select the statement/s that correctly characterize/s available cardiovascular risk assessment tools.
Answer: B. Some validated CV risk assessment tools are limited by incorporating race as a risk factor. "Because it is well documented that race is a social construct, the AAFP encourages family physicians to be aware of the inappropriate use of race as a proxy for biology or genetics in clinical decision-making."
5. Which following correspond/s to AAFP Recommendation 2 to target a lower blood pressure (<135/85 mm Hg), to reduce risk of myocardial infarction (MI)?
Answer: D. None of the above. "Targeting to lower blood pressure goals in the general population did not appear to improve outcomes in this review; however, it is not clear whether certain subgroups in the population would benefit from lower targets."
6. Which of the following should be a consideration discussed in shared-decision making when considering a lower blood pressure target to reduce risk for MI?
Answer: E. All the above. "Although the potential for a small decrease in myocardial infarction risk at lower blood pressure targets occurs, there is also the potential for increased harms...."
7. According to a systematic review from the Cochrane Database of Systematic Reviews cited in the AAFP guideline, the absolute risk increase for adverse events such as syncope and hypotension when treating to lower than standard guideline recommended blood pressure level target is which of the above?
Answer: B. 3%. In a subgroup analysis of 6 trials involving 18,938 participants, a 6.8% incidence of adverse events associated with standard blood pressure target of <140/90 increased to 9.9% with lower target of <135/85.
Which of the following statements on obtaining accurate blood pressure readings in the clinic are true, which false?
FALSE. 'Workflows should be established to allow for accurate blood pressure measurements. This could include allowing patients to sit for several minutes in the room to acclimate..."
FALSE. "While measuring blood pressure, a patient's feet should be flat on the floor and the arm supported with the cuff at the level of the heart."
FALSE. "Blood pressure measurements should be obtained at multiple time points during the visit; with the averaging of measures being a better indicator of status than single measurement."
FALSE. "It is recommended that a patient's bladder be empty, that caffeinated beverages be avoided for 30 minutes prior, and that the patient rest for five minutes before measuring blood pressure."
Source: Coles S, Fisher L, Lin KW, Lyon C, Vosooney AA, Bird MD. Blood Pressure Targets in Adults With Hypertension: A Clinical Practice Guideline From the AAFP. Am Fam Phys. 2022;106:(6). https://www.aafp.org/pubs/afp/issues/2022/1200/practice-guidelines-aafp-hypertension-full-guideline.html
