Inconsistent Hypertension Guidelines: We Need a Little Help Here

To the Editor My colleagues and I in primary care are figuring out what to do with the hypertension guidelines announced in November 2017.¹ The guidelines were endorsed by the American College of Cardiology, American Heart Association, American Society for Hypertension, and almost every other cardiology organization in existence.¹ Notably missing among the organizations endorsing the guidelines were the 2 primary care organizations that represent the majority of physicians who actually treat hypertension everyday: the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP). These organizations issued their own guidelines 6 months earlier, with recommendations for blood pressure management of adults older than 60 years. Those guidelines recommend a target systolic blood pressure of less than 150 mm Hg—distinctly different from the target recommended by the new joint statement, which recommends a target less than 130 mm Hg.² This remarkable lack of consensus complicates the decision-making process for practicing clinicians and creates confusion.