5 Things About the New Hypertension Guidelines

On Monday, the American Heart Association (AHA) and the American College of Cardiology unveiled new clinical guidelines for treating hypertension, marking the first major update since 2003. Hypertension, which occurs when there is too much pressure of blood against the walls of the arteries, is the second leading cause of heart disease after smoking. The new guidelines will have a ripple effect across healthcare, changing treatment protocols, data reporting, and whether practices and health systems are succeeding in population health. Here are 5 things to know about the new hypertension guidelines:

1. The threshold for high blood pressure is lower. There are new categories for blood pressure, but here’s the bottom line: high blood pressure is now 130/80 mm Hg, not 140/90 mm Hg. Normal blood pressure is still 120/80 mm Hg, but the category of prehypertension is eliminated. Now, blood pressures between 120/80 mm Hg and 130/80 mm Hg are considered elevated.
2. Nearly half of adults in America now have high blood pressure. The new definition means 103.3 million Americans, or 46% of all US adults, have high blood pressure. That’s up from around one-third of American adults under the old criteria, an increase of about 14%. Experts at AHA insisted, however, that their recommendations only call for another 1.9% of Americans to receive a recommendation for more medication.
3. Lifestyle modification is the foundation. The key takeaway at this week’s meeting of the AHA is that doctors must make a renewed effort to get patients to eat better and exercise more. The Heart Association plans a public campaign with the Ad Council to promote the guidelines and the need for healthy lifestyles. As Paul Whelton, MD, MSc, the guideline committee chair said, just because change is hard doesn’t mean the healthcare community shouldn’t try.
4. High blood pressure has stages. Stage 1 begins at 130/80 mm Hg and stage 2 begins at 140/90 mm Hg. Medication is not automatic at stage 1; it is only recommended if a patient has other risk factors. Both lifestyle modification and medication are recommended once a patient reaches stage 2. A hypertension crisis occurs if a patient’s blood pressure reaches 180/120 mm Hg, which may require hospitalization.
5. The guidelines call for team-based care. And, the patient is part of the team. Out-of-office monitoring, involving pharmacists, nurses, and at-home monitoring by the patient, will bring better hypertension management and help address “white coat” syndrome, experts at AHA said. The guidelines call for measuring blood pressure at least twice before making a hypertension diagnosis, and give specific instructions for how to measure blood pressure.

For more from the 2017 American Heart Association Scientific Sessions, visit our conference page at ajmc.com.