HYPERTENSION
(compiled by Victoria YY Xu, MD FRCPC; updated Oct 2019)
Hypertension Canada (2018)
• SBP <140 mmHg & DBP <90 mmHg in those without other compelling indications (no comment on age or frailty status)
NICE (2019)
• BP <140/90 mm Hg in people <80 years
• BP <150/90 mm Hg in people ≥80 years and use clinical judgement for those with frailty or multimorbidity
ACC/AHA (2017)
• SBP <130 mmHg in non-institutionalized ambulatory community-dwelling older adults (≥ 65 years)
• Warned about risk of adverse outcomes with intensive BP lowering among the frailest patients
Eighth Joint National Committee (JNC 8) 2014
• BP <150/90 mmHg for adults aged ≥ 60 years
• BP <140/90 mmHg for adults aged < 60 years
ESC/ESH (2018)
• Target SBP130–139 mmHg in individuals ≥ 80 years, if tolerated
• Treatment should never be denied or withdrawn on the basis of age, provided that treatment is tolerated
CALCULATORS
ePrognosis - link
A collection of clinical tools useful for:
1. Prognostication: it will ask you about care setting (e.g. nursing home or hospital) and then, depending on your answer, it will ask follow-up questions to determine the best tool.
2. Appropriateness of cancer screening: it will ask you whether or not you are interested in colorectal, breast, or both colorectal and breast cancer screening before beginning questions from the appropriate tool.
(Instructions by Jenn Watt, MD PhD FRCPC)
GUIDELINES AND RESOURCES
Centre for Effective Practice:
- Clinical tools geared towards family physicians (including MAID toolkit)
Canadian Task Force
Canadian Diabetes Guidelines for Older Adults
Osteoporosis Guidelines
Ontario Palliative Care Network
Geriatric Choosing Wisely
CMAJ Geriatrics Resource Collection
DEPRESCRIBING
Med Stopper creates a medication plan for your patients
Institute for Safe Medications Canada
Deprescribing.org - algorithms for deprescribing, phone app and other resources