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
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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.
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Social determinants including poverty, poor education, unemployment, homelessness and childhood abuse increase the risk for both mental and physical disorders.
“Social determinants including poverty, poor education, unemployment, homelessness and childhood abuse increase the risk for both mental and physical disorders.89,292”
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- Authors
- Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. (. R., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S.
- Affiliations
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 71
- Issue
- 19
- Pages
- 2176-2198
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC8654280
- OpenAlex
- W3149811656
- Cited by
- 221
- References
- 100
- Citations by year
- 2026: 2 · 2025: 15 · 2024: 17 · 2023: 13 · 2022: 23 · 2021: 29 · 2020: 42 · 2019: 53 · 2018: 23 · 2017: 4
- FWCI
- 4.70
- Type
- journal article
- Language
- en
- Update notices
- erratum (2018-05-15)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (CC999999)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- hypertension, self-measured blood pressure, office blood pressure measurement, antihypertensive therapy, blood pressure targets, first-line antihypertensive drugs, thiazide-like diuretics, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, cardiovascular outcomes, blood pressure control
- MeSH terms
- Adult, American Heart Association, Antihypertensive Agents, Cardiology, Humans, Hypertension, United States, Practice Guidelines as Topic, Disease Management, Advisory Committees, Research Report
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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