New guidelines released to manage hypertension treatment

Article written by Weston Malek, MPH

Last year, the American Heart Association (AHA) and American College of Cardiology (ACC) released a joint guideline changing the criteria used to diagnose and treat high blood pressure. As doctors will soon begin to use these new guidelines to manage hypertension treatment, it’s important to consider what this will mean for patients.

High blood pressure, or hypertension, had previously been defined by guidelines as blood pressure ≥ 140/90 mmHg. As such, about 72 million American adults were considered to have hypertension and it is one of the most commonly diagnosed chronic conditions. Under the new guideline criteria, anyone with systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg will now be diagnosed as hypertension. This results in an additional 29 million hypertensive Americans. However, the AHA/ACC statement suggests that only a small percentage – about 4.2 million people – of newly-diagnosed adults will be recommended to use blood pressure-lowering medications that are already suggested to those diagnosed according to the previous guidelines.

The reason only a fraction of those now considered hypotensive will receive medication treatment is because the guidelines distinguish those with blood pressures ranging from 130-139 mmHg systolic blood pressure or 80-89 mmHg diastolic blood pressure as having stage 1 hypertension, and those with higher blood pressures (≥ 140 mmHg systolic blood pressure or ≥ 90 mmHg diastolic blood pressure) to have stage 2 hypertension. In stage 1, the primary recommendation is to address high blood pressure with lifestyle changes, such as following the DASH diet with an emphasis on fruits and vegetables, reducing sodium intake, increasing potassium intake, exercising 90 to 150 minutes per week, and maintaining a healthy body weight. Only those diagnosed with stage 1 hypertension at a heightened risk of developing heart disease or stroke within 10 years are recommended to start on blood pressure-lowering medication in addition to lifestyle changes. Those at higher risk include patients with cardiovascular disease, diabetes, or chronic kidney disease, or those who have a > 10% risk using the AHA’s atherosclerotic cardiovascular disease (ASCVD) risk calculator (available online at: http://static.heart.org/riskcalc/app/index.html#!/baseline-risk).

So, while the change in the number of people diagnosed with high blood pressure according to new guidelines seems alarming, the majority of individuals will not see a significant change in their doctor’s recommendations. Overall, the criteria change represents a need to shift perception about the risk associated with high blood pressure and begin to make dedicated efforts to lower blood pressure earlier.

References

1. Whelton PK, Carey RM, Aronow WS, et al. 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. Hypertension. 2017 Nov 13. doi: 10.1016/j.jacc.2017.11.006.

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