New hypertension definitions in ACC/AHA guidelines
High blood pressure should be treated earlier with lifestyle changes and in some patients with medication - at 130/80 mm Hg rather than 140/90 - based on new American College of Cardiology and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure. The guidelines extend findings from the Seventh Report of the Joint National Committee (JNC7) and the Expert Panel Report on managing blood pressure to include updated data from clinical trials and by accentuating previously underemphasized sections of the 2003 and 2013 reports.
The guidelines now define normal blood pressure as below 120/80 mm Hg and elevated blood pressure as 120 to 129 mm Hg systolic with a diastolic pressure below 80 mm Hg. Stage 1 hypertension is defined as 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic, and stage 2 hypertension as 140/90 mm Hg or higher (the old definition of hypertension).
There is a focus on proper blood-pressure measurement and encouragement of home blood-pressure monitoring and initial combination medications for lowering blood pressure. The guideline also highlights the failure to position patients and their arms appropriately, utilize the proper cuff size, or allow time to rest before performing three blood-pressure readings can result in falsely elevated readings. In addition, proper instruction of patients in measuring their blood pressure at home is critical, as is annual validation of their machines.
In terms of medications, the use of initial single-pill combination medications for patients with blood pressures either 20 mm Hg above the systolic target or 10 mm Hg above the diastolic target is strongly supported. Renin-angiotensin blockers with either diuretics or calcium antagonists are preferred initial combinations.
Unlike previous guidelines, the 2017 guideline emphasizes individualized cardiovascular risk assessment and aggressive management of blood pressure at levels of 140/90 mm Hg or higher in patients with a 10-year risk of cardiovascular events of more than 10%. Patients with blood pressures of 130 to 139/80 to 89 mm Hg would still receive nonpharmacological treatment, unless they had a 10-year risk above 10%; in that case, a single antihypertensive agent is recommended, in concert with lifestyle changes.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA 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 2017 November 13 (Epub ahead of print).