| Course | PA 502 Evidence Based Medicine |
|---|---|
| Week | 6 |
| Paper type | Guideline comparison |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 502 Week 6
Guideline Comparison: What ACC/AHA 2017 and ACP/AAFP 2017 Tell a Clinician About the Systolic Target for a 76-Year-Old With Hypertension and Kidney Disease, and Where They Part
Student Name
Chamberlain University
PA 502: Evidence Based Medicine
Instructor Name
Month Day, Year
Guideline Comparison: What ACC/AHA 2017 and ACP/AAFP 2017 Tell a Clinician About the Systolic Target for a 76-Year-Old With Hypertension and Kidney Disease, and Where They Part
The Question, Held Still
What systolic goal should be set for the course's 76-year-old patient, whose hypertension is treated and whose kidneys are mildly impaired, with no diabetes and no prior stroke? Two guidelines published within months of each other in 2017 and 2018 answer this question differently. This paper reports what each tells a clinician to do, in its own words where possible, locates exactly where they part and works through the likely reasons before reaching for explanations about motive.
What Each Document Says
The American College of Physicians and the American Academy of Family Physicians recommend that clinicians start treatment in adults aged 60 or older whose systolic pressure is persistently at or above 150 mm Hg, "to achieve a target systolic blood pressure of less than 150 mm Hg," which they rated strong and based on evidence of high quality. They also recommend considering a target below 140 mm Hg for adults 60 or older with a prior stroke or transient ischemic attack, and for "some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment," each graded as weak. And they recommend that clinicians choose goals "based on a periodic discussion of the benefits and harms of specific blood pressure targets with the patient" (Qaseem et al., 2017).
The 2017 cardiology-led guideline from the ACC and AHA, written with nine other organizations including the American Academy of PAs, recommends a target below 130/80 mm Hg for adults with hypertension and chronic kidney disease, and a systolic target below 130 mm Hg for noninstitutionalized, ambulatory, community-dwelling adults 65 or older (Whelton et al., 2018).
Where Exactly They Part
Table 1
The Two Guidelines on One Question
| Element | ACP/AAFP 2017 | ACC/AHA 2017 |
|---|---|---|
| Default target, adults 60 or 65 and older | Below 150 mm Hg systolic, strong recommendation | Below 130 mm Hg systolic for ambulatory community-dwelling adults 65 and older |
| High cardiovascular risk | Consider below 140, weak recommendation, individualized | Below 130/80 for chronic kidney disease |
| Role of the patient | Periodic discussion of benefits and harms | Clinical judgment and patient preference for older adults with high comorbidity or limited life expectancy |
| How evidence is graded | GRADE: strength and quality | Class of recommendation and level of evidence |
Note. Note. Wording from Qaseem et al. (2017) and Whelton et al. (2018).
For my patient, the guidelines part at a specific point: ACP/AAFP would accept a systolic pressure in the 140s and consider below 140 only after individualized assessment of high risk, while ACC/AHA would aim below 130 because of both age and kidney disease.
The Dull Causes First
Before explaining the difference by who wrote each document, the ordinary causes deserve a look. The first is the question each guideline asked. ACP/AAFP asked about adults aged 60 or older as a group and weighed the trials that tested targets in that population, giving most weight to mortality, stroke and cardiac events with high-quality evidence. ACC/AHA asked about many populations, including chronic kidney disease, and set targets for each. The second is how each graded evidence: ACP/AAFP used the GRADE system, which rates a recommendation strong only when the evidence is of high quality and the balance clear; ACC/AHA used its own class and level system, which can make a strong recommendation from a single large randomized trial. The third is how each weighed SPRINT, which drove the lower target: SPRINT found fewer cardiovascular events and deaths with a target below 120 but also more serious hypotension, syncope, electrolyte problems and kidney injury (SPRINT Research Group, 2015). A panel that gives heavy weight to the measurement method in SPRINT and to harms in older adults will be more cautious about a lower target.
Who Was in the Room
Only after those causes does the composition of each panel help. ACP/AAFP's panel came from general internal medicine and family medicine, specialties that see many older patients with several conditions in settings where measurement is less controlled. ACC/AHA's panel was led by cardiology and hypertension specialists and included many societies. Each group brings its own experience of harms and benefits. That is not an accusation of bias; it is a reminder that judgment enters at the step where evidence is translated into a target.
What a Clinician Should Do With Both
For my patient, the guidelines agree on one thing: the decision should involve the patient. They disagree on the default. A clinician can respect both by measuring blood pressure properly, setting out the benefits and harms of a lower target in numbers the patient can weigh, and treating the patient's informed choice as the target, while documenting which guideline the plan follows and why.
What Each Would Do With My Patient
Applied literally, the ACP/AAFP guideline would leave my patient's treatment as it is, since the patient's systolic pressure of about 138 at home and 146 in the clinic is below 150. A clinician following it might consider below 140 after weighing the patient's kidney disease as a sign of high cardiovascular risk, but would not be directed to aim below 130. Applied literally, the ACC/AHA guideline would call for adding or increasing a medicine to bring the patient's pressure below 130, because the patient is over 65, ambulatory and has chronic kidney disease. Two careful clinicians, each following a guideline faithfully, could therefore give my patient opposite advice at the same visit. For the patient, that disagreement is confusing unless someone explains that both documents are reasonable readings of the same trials, made by different groups asking slightly different questions.
What Has Happened Since
Both guidelines are now several years old, and later evidence and updated guidance may have moved the field, especially toward lower targets for fit older adults. Some of that later guidance comes from organizations outside the United States, which may use different measurement assumptions and different age cutoffs again, so any newer document needs the same careful reading of its qualifying clauses as these two received here. A clinician should check for updates, and for any newer trials in older adults, before relying on either document, and should note the publication date of whichever guideline is used in the patient's record.
References
Qaseem, A., Wilt, T. J., Rich, R., Humphrey, L. L., Frost, J., & Forciea, M. A. (2017). 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. Annals of Internal Medicine, 166(6), 430-437. https://doi.org/10.7326/M16-1785
SPRINT Research Group. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103-2116. https://doi.org/10.1056/NEJMoa1511939
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner, P., Ovbiagele, B., Smith, S. C., Spencer, C. C., Stafford, R. S., Taler, S. J., Thomas, R. J., Williams, K. A., . . . Wright, J. T. (2018). 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: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. https://doi.org/10.1161/HYP.0000000000000065
Reading the PA 502 Week 6 instructions
Week six asks you to compare two guidelines on a single clinical question. State the question and hold it fixed. Report what each guideline tells a clinician to do, in its own words where possible, keeping qualifying clauses such as "some adults" or "individualized assessment." Identify exactly where the two documents diverge. Explain the divergence starting with ordinary causes, such as the question each panel asked, the populations covered, the evidence considered and the grading system, before considering who was on each panel. Apply both guidelines to one patient to show the practical difference. Avoid attributing differences to motive without evidence, and say what a clinician should do with both.
How the PA 502 Week 6 example is put together
The comparison fixes the question on the target for the course's older patient, who has kidney disease but no diabetes or stroke. It quotes ACP/AAFP's strong recommendation to treat to below 150 for adults 60 and older, its weak recommendations to consider below 140 after stroke or for some at high risk, and its call for periodic discussion with patients. It reports ACC/AHA's targets below 130/80 for chronic kidney disease and below 130 for ambulatory adults 65 and older. A table shows where they part. The analysis then considers scope, GRADE versus class and level, and the weighing of SPRINT's harms before panel composition, and shows the two guidelines giving the same patient opposite advice.
Where the points sit in the PA 502 Week 6 rubric
The comparison that loses most is two summaries in parallel with no sentence at the point where the documents actually diverge. It is the easiest version to write and answers nothing. The next is the leap to motive, where a difference is attributed to industry influence or specialty bias before any ordinary cause is considered. Comparisons that drop qualifying clauses, shift between questions or never apply the guidelines to a patient also lose points. Strong comparisons hold one question, quote each guideline with its conditions, locate the divergence precisely, explain ordinary causes first, consider panel composition last and say what a clinician should do with both. Checking whether either document has been updated is a final step that careful readers notice.
PA 502 Week 6 help from the desk
Guideline comparisons tempt students to summarize each document separately, which leaves the comparison undone. If you share the two guidelines and the question, we can help you quote each one accurately with its conditions, find the exact point of divergence and work through the ordinary reasons before considering who wrote them. We can also help you apply both to one patient. Your comparison and conclusions remain your own. If newer versions of either guideline exist, we can help you check whether the divergence still stands before you build the paper around it. We can also help you decide which guideline your clinic should document as the basis for a plan, and how to say so in the chart.
Get a PA-502 Week 6 example written to your instructions
Send both documents your section named, or their titles and years, along with the assignment instructions, since the whole comparison turns on the specific editions in front of you and guidelines are revised often enough that a year matters. A custom PA-502 Week 6 comparison is written to your rubric and returned inside 24-48h, first one at no charge.
More PA 502 papers and MPAS samples
- PA 502 Week 1: Clinical Question Post
- PA 502 Week 2: Bedside Question Brief
- PA 502 Week 3: NNT Calculation
- PA 502 Week 4: Surrogate Outcome Critique
- PA 502 Week 5: Applicability Write-Up
- PA 502 Week 7: Decision Aid Draft
- PA 502 Week 8: Journal Club Brief
- PA 501 Week 6: Care Team Map
PA 502 Week 6 questions, answered
One document is much newer. Does that settle it?
Not on its own, though it is the first thing to check and it often explains most of the gap. A newer document may simply have had a large trial available. It may also have been produced by a group with a narrower remit. Report the two cut-off dates, say what appeared between them, and let that carry as much of the explanation as it honestly can.
Do I have to read both documents in full?
The recommendation table and the methods appendix carry most of what this assignment needs, and the appendix is where the cut-off date and the panel composition sit. Read the full text around the specific recommendation under comparison. Check your section wording, since some ask for a set number of recommendations rather than a whole document.
Can the comparison end without choosing?
It can end without declaring one document better overall, and most good ones do, but it should not end without saying what you would do for a patient. Name the position you would take on the specific question, give the reason, and state the fact that would move you to the other document. An ending that lists differences and stops reads as unfinished.
Where can I find a free PA 502 Week 6 sample paper?
You can read the full PA 502 Week 6 comparison of the ACC/AHA and ACP/AAFP blood pressure guidelines on one question on this page.
Where do the guidelines part in the PA 502 Week 6 sample?
ACP/AAFP sets a default below 150 for adults 60 and older, while ACC/AHA aims below 130 for ambulatory adults 65 and older and for chronic kidney disease.