The American Heart Association, American College of Cardiology and several other health organizations released a comprehensive new guideline with recommendations regarding the diagnosis, treatment and prevention of hypertension. The new guideline lowers the target for blood pressure treatment to 130/80 mmHg. This emphasizes the importance of early prevention, detection and treatment to reduce future cardiovascular risk.
Top 5 Takeaways for Your Practice
Classification of Blood Pressure: Four new BP categories based on the average of two or more in-office blood pressure readings.
- Normal: < 120 mm Hg Systolic BP (SBP) and < 80 mm Hg Diastolic BP (DBP)
- Elevated: 120-129 mm Hg SBP and < 80 mm Hg DBP
- Stage 1 Hypertension: 130-139 mm Hg SBP or 80-89 mm Hg DBP and
- Stage 2 Hypertension: ≥ 140 mm Hg SBP or ≥ 90 mm Hg DBP
Prevalence of High Blood Pressure: Substantially higher prevalence of HBP under the new guideline, 46% of U.S. adults versus 32%, based on the JNC 7 definition. However, for most U.S. adults meeting the new definition of hypertension that would not meet the JNC 7 definition, nonpharmacological treatment is recommended. Because most people between 130-139 mm Hg SBP or 80-89 mm Hg DBP will not require medication to treat their hypertension, there will only be a small increase in the percentage of U.S. adults for whom antihypertensive medication is recommended in conjunction with lifestyle modification. Commit to helping your patients by implementing a BP Improvement Program
Treatment of High Blood Pressure: All patients with blood pressures above normal should be treated with nonpharmacological interventions. For most adults these include consuming a heart-healthy diet such as DASH, reducing sodium intake, increasing physical activity, limiting alcohol consumption and losing weight for those who are overweight. Pharmacological Interventions: Use of BP-lowering medications is recommended based on stage of hypertension, an individual’s medical history or estimated 10-year CVD risk ≥ 10% using the ACC/AHA Risk Estimator. Learn more about treating hypertension
Blood Pressure Goal for people with High Blood Pressure: For adults with confirmed hypertension and known CVD, or 10-year ASCVD event risk of 10% or higher, a BP goal of less than 130/80 mm Hg is recommended. For adults without additional markers of increased CVD risk, a BP goal of less than 130/80 mm Hg may also be reasonable. The totality of the available information provides evidence that a lower BP target is generally better than a higher BP target. The SBP target recommended in the new guideline (<130 mm Hg) is higher than that which was used in the SPRINT trial (<120 mm Hg). Learn how to improve blood pressure control rates
Use Self-measured Blood Pressure Monitoring (SMBP) to Diagnose, Reassess, and Activate Patients with High Blood Pressure: SMBP refers to the regular measurement of BP by an individual, at their home or elsewhere outside the clinic setting. SMBP can be used for confirmation of hypertension diagnosis based on elevated office readings and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions. SMBP can help differentiate between sustained, white coat, and masked hypertension. SMBP can also be used for reassessment of patients (at 1, 3, 6 or 12 month intervals) per new guideline recommendations. Learn more about SMBP
Watch: TEDMED Discussion
An intimate discussion about the new BP Guideline
TEDMED, the AHA and AMA brought together an expert panel to discuss the Hypertension Guideline and what it means to clinical practice.