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Individualized Treatment Guidelines for Hypertension Prevent MI, Stroke

Margaret Dick Tocknell, for HealthLeaders Media, May 3, 2011

Developing individualized treatment guidelines for the management of hypertension reduces more myocardial infarctions (MIs) and strokes than following the current national guidelines, researchers find.

Compared to using no guidelines at all individualized guidelines for the treatment of hypertension could prevent 43% more MIs and strokes than the use of national guidelines from the Seventh Report of the Joint Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7).

What accounts for the difference is that "national guidelines are designed to be easy to remember and easy to follow, they typically focus on only one risk factor or condition at a time, and draw sharp thresholds for treatment" explains David M. Eddy, MD and PhD, the lead author for Individualized Guidelines: The Potential for Increasing Quality and Reducing Cost, published in the Annals of Internal Medicine.

According to the JNC 7 hypertension guidelines, a patient should be treated for hypertension when the systolic blood pressure reaches 140 (or 130 if the patient has diabetes or chronic kidney failure).

"In fact, there are multiple, interconnected risk factors that should be taken into account for blood pressure treatment. We looked at how computer models could be used to simultaneously assess all of the important risk factors and develop individualized recommendations for treating hypertension," said Eddy.

The goal of the study was to determine the potential health and economic benefits of using individualized guidelines versus current guidelines. The team compared outcomes when the treatment for a patient's blood pressure was based upon:

  • Standard guidelines from JNC 7
  • Individualized guidelines that consider patient age, sex, blood pressure, cholesterol, family history as well as diabetes and smoking status
  • Using no guidelines at all

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