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PPRNet - Primary (Care) Practices Research Network

Blood Pressure Management

  • Blood pressure measurement every 2 years in all adult patients
  • Diagnosis of hypertension in patients with 3 blood pressure measures equal to or higher than 140/90 mmHG 
  • Blood pressure measurement in patients with hypertension every six months
  • Blood pressure measurement less than 140/90 mmHg in patients with hypertension  
  • Ace inhibitor (or ARB) prescribed for patients with DM and HTN 

Reference: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)

Lipid Management

  • Cholesterol screening every 5 years for all male patients 35 years of age or older and all female patients 45 years of age or older.
  • Annual measurement of LDL-cholesterol for patients with coronary heart disease or other atherosclerotic disease
  • LDL-cholesterol control < 100 mg/dl in patients with coronary heart disease or other atherosclerotic disease
  • Lipid lowering prescription for patients with coronary heart disease or other atherosclerotic disease

Reference: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Full Report and 2004 Update

Aspirin Chemoprevention
Aspirin or anti-platelet agent perscription for all adult patients with coronary disease or atherosclerosis, and men aged 45-79 years diagnosed with tabacco abuse, hyperlipidemia, or hypertension.  
The US Preventive Services Task Force (USPSTF) recommends the use of aspirin for male patients 45-79 years of age and female patetients 55-79 years of age when the potential benefits (a reduction in myocardial infarctions in males, and a reduction in ischemic strokes in females) outweight the potential harm of an increase in gastrointenstinal hemorrhage.  Age and sex are the most important risk factors for gastrointestinal bleeding and other risks include upper gastrointestinal tract pain, gastrointestinal ulcers, and non-steroidal anti-inflammatory drug (NSAID) use.  While patients 80 years of age or older carry significant cardiovascular risk, they are also in the highest risk group for gastrointestinal bleeding.  Therefore the USPSTF also concluded that the current evidence is insufficient to assess benefits and harms for this group of patients.

Reference: USPSTF: Aspirin for the Prevention of Cardiovascular Disease

Atrial Fibrillation
Anticoagulant or anti-platelet therapy prescription for patients with atrial fibrillation

Reference: Antithrombotics in Atrial Fibrillation, From the ACCP Evidence-based Clinical Practice Guidelines (8th edition)

Heart Failure
ACE inhibitor (or ARB) and ß-blocker prescribed for patients with heart failure

Reference: Heart Failure Society of America Guidelines Page (see Section 7: Heart Failure in Patients with LV Systolic Dysfunction)

Abdominal Aortic Aneurysm 
Abdominal Aortic Aneurysm (AAA) screening once after age 65, in men ages 65-75 years old with any history of tobacco use.
The US Preventive Services Task Force (USPSTF) recommends a one time screening for AAA by ultrasonography in all male patients ages 65-75 who have any history of smoking. The USPSTF found good evidence that screening for AAA and surgical repair of large AAAs in these patients leads to a decrease in morality caused by AAA. The USPSTF, acknowledges the harms of screening and early treatment, including increased number of surgeries associated with clinically-significant morbidity and mortality as well as psychological harms. Given the lower prevelance of AAA in males that are non-smokers vs. those who are smokers, the USPSTF issues no reccomendation for or against screening for AAA in males who are nonsmokers, declaring that the balance between the benefits and harms is too close to make a judgement. The USPSTF does, however, recommend AGAINST screening for AAA in women, declaring that due to the low prevelance of large AAAs in women, and thus the limited number of deaths that could be prevented, the harms of screening actually outweigh the benefits.

Reference: USPSTF: Screening for AAA


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