Veterans need to be aware of VA-sponsored research into hypertension treatment that led to new guidelines being published yesterday.
The new guidelines address how best to treat hypertension while avoiding many of the condition’s known complications. Known complications from hypertension evaluated in the new guidelines were outcomes involving all-cause mortality, morbidity and mortality related to stroke, major cardiac events (fatal and nonfatal myocardial infarction and sudden cardiac death), and harms.
To summarize the recommendations:
- Veterans with a host of complications linked to hypertension should be included in developing the treatment plan, and that treatment plan should not be overly aggressive in addressing the systolic pressure level. Strong evidence shows treatment of hypertension with systolic readings >160 reduces mortality and is of benefit regardless of whether the patient has diabetes.
The new hypertension guidelines that I list out below were created by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) following research sponsored by the Department of Veterans Affairs.
Be Active In Your Own Health Care
Veterans facing problems with hypertension or related complications need to be aware of the new guidelines to ensure their VA doctors are using current medical standards when providing treatment.
Some VA medical centers tend to lag behind certain developments in standard of care in the community when new guidelines are published. Meaning, some very well-intended doctors may not be using current treatment methods required of the profession in the community.
This makes it incumbent on affected veterans to be active participants and researchers in the health care they receive.
VA Evidence-based Synthesis Program
The Veteran research conducted was part of the Portland VA Health Care System Evidence-based Synthesis Program, called “ESP” by the agency. According to VA:
“The VA Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to clinicians, managers and policymakers, as they work to improve the health and healthcare of Veterans. HSR&D provides funding for four ESP Centers and each Center has an active University affiliation. The Centers include: Durham, Minneapolis, Portland, and West Los Angeles Veterans Affairs Medical Centers. The Center directors are national and international leaders in the field of evidence synthesis with close links to the AHRQ Evidence-based Practice Centers.”
New Hypertension Treatment Guidelines
The research conducted in Portland led to the following three recommendations:
“ACP and AAFP recommend that clinicians initiate treatment in adults aged 60 years or older with systolic blood pressure persistently at or above 150 mm Hg to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. (Grade: strong recommendation, high-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.”
Evidence supporting this recommendation was considered “high-quality” for treating hypertension in older adults to moderate targets (<150/90 mm Hg). The benefit of the treatment was to reduce mortality (ARR, 1.64), stroke (ARR, 1.13), and cardiac events (ARR, 1.25). Benefits are experienced by affected adults irrespective of whether they have diabetes. The greater benefit was for patients with higher mean SBP at baseline (>160 mm Hg). Otherwise, the benefits experienced from aggressive BP control was small. The outcomes were inconsistent and with a lower magnitude of benefit.
“ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in adults aged 60 years or older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. (Grade: weak recommendation, moderate-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.”
Evidence supporting this recommendation was considered “moderate-quality” for treating hypertension in older adults. These adults had previous TIA or stroke to an SBP target of 130 to 140 mm Hg. This practice reduces stroke recurrence (ARR, 3.02) compared with treatment to higher targets and it has no statistically significant effect on cardiac events or all-cause mortality.
“ACP and AAFP recommend that clinicians consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Grade: weak recommendation, low-quality evidence). ACP and AAFP recommend that clinicians select the treatment goals for adults aged 60 years or older based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient.”
READ IT IN FULL: Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians
Basics On Filing Tort Claim
Veterans injured by health care they receive from VA should consider filing a tort claim for malpractice you can initiate by filing an SF-95 at your medical facility or an § 1151 claim through your regional office.
Veterans cannot receive payment under both options and will need to choose the outcome they seek. Below is an easy summary to help you figure out which is best for you.
The upside of the tort is that you receive a one-time payment. Elderly veterans may want to consider this option or veterans with severe injuries only compensable through large settlement.
The upside of the § 1151 claim is that your disability compensation rating will increase and the veteran may become entitled to new benefits such as coverage for in-home treatments or assisted living support.
Each veteran’s case and situation is unique, and would require some thought and planning when deciding which direction to go.
If the treatment was linked to an existing service-connected disability, that veteran could receive an award both through the tort claim and service-connection linked to the existing service-connected disability.