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  • Critical Changes to Hypertension Guidelines

    Prevention or earlier treatment of hypertension has the potential for substantially improved outcomes, therefore the need for comprehensive, updated guidance regarding diagnosis and management continually increases. Estimates have indicated that approximately 75 million adults in the US are hypertensive. Data from 2014 showed that high blood pressure was a primary or contributing cause of more than 1,100 deaths per day. It is a condition that also costs the nation nearly $50 billion each year. Recent renovations have been made on clinical practice guidelines for addressing these dramatic statistics.

    The revised guidelines mark the first comprehensive set since 2003. They incorporate new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring, home BP monitoring, BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control, and various other important issues. With heightened blood pressure, the risk for CVD increases in a log-linear fashion, from systolic BP (SBP) levels <115mmHg to >180mmHg and from diastolic BP (DBP) levels <75mmHg to >105mmHg. Levels of 20mmHg higher SBP and 10mmHg higher DBP are each associated with a doubled risk of death from stroke, heart disease or other vascular disease.

    The prevailing guidance from the American College of Cardiology (ACC) and American Heart Association indicates that high blood pressure should be treated earlier with lifestyle changes and in some patients with medication at 130/80mmHg rather than 140/90mmHg. The updated definition will result in nearly half of the US adult population (46%) now being classified as having high blood pressure. Included in the revision is the elimination of the prehypertension category. The overall changes serve to account for complications that can occur at lower numbers and to allow for earlier intervention. Only a small increase is expected in the number of adults requiring antihypertensive medications, as the updated guidelines only suggest prescription medication or Stage I hypertension if a patient has a high risk of heart attack or stroke based on age and history of a cardiovascular event, diabetes mellitus, chronic kidney disease, or elevated atherosclerotic risk. Virtual tools are available to assist with understanding and implementing the updated guidelines into practice. The ACC’s free guideline app provides access to all of the clinical guideline recommendations and offers users interactive tools such as risk scores, dosing calculators and algorithms. The app is available through iTunes® and Google Play™.

    Fine-tuning the approach to monitoring blood pressure is strong strategy for making a positive impact on patient health. To be most effective, patients must also have greater awareness regarding blood pressure and helping them focus their understanding of the importance of keeping close tabs on treatment and control is also a principle goal. For new and updated drug information, update or register your profile to receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app, available now for free from your favorite app stores.


    New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. American College of Cardiology Foundation website. http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Accessed May 19, 2018.

    Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief, No. 133. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. https://www.cdc.gov/nchs/data/databriefs/db133.pdf

    Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith Jr SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr KA, Williamson JD, Wright Jr JT, 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, Journal of the American College of Cardiology (2017), doi: 10.1016/j.jacc.2017.11.006.