An overview of new hypertension guidelines

New definitions:

  • Normal BP: <120/80 mmHg
  • Elevated BP “Pre HTN”: 120-130/<80
  • Stage 1 HTN: 130-140/80-90
  • Stage 2 HTN: >140/90

 

New targets for treatment:

  • If ASCVD 10-year-risk is <10%, then target BP <140/90
  • If ASCVD 10-year-risk is ≥10%, then target BP <130/80
    • Established CVD
    • DIABETES
    • CKD
    • AGE>65  and “healthy”

 

GT

 


Also see:

2017 ADA position statement: hypertension in diabetes

New HTN treatment: Baroreflex activation therapy (BAT)

Review of resistant hypertension

Important indicators of masked hypertension

White coat syndrome in refractory hypertension

Systolic Blood Pressure in Older Adults >75

Comprehensive review of blood pressure in type 2 diabetes

Systolic Blood Pressure and Mortality in Individuals >80


Hypertension

Guidelines

November 2017


Timeline:

  • 2003: JNC 7 – the last major credible guidelines
  • 2014: JNC 8 – debunked, particularly for setting a target BP <150/90 mmHg for all patients > 60 of age.
  • 2017: The new ACC/AHA guidelines are considered to be the true continuation of JNC 7

 

Facts about new guidelines:

  • 11 health professional organizations participated.
  • Panel was composed of 21 scientists and health experts.
  • More than 900 publications were used.
  • In 2013, the NHLBI asked the AHA and ACC to proceed with development of new blood pressure guidelines.

 

New definitions (best to check BP at home):

  • Normal BP: <120/80 mmHg
  • Elevated BP “Pre HTN”: 120-130/<80
  • Stage 1 HTN: 130-140/80-90
  • Stage 2 HTN: >140/90

 

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

 

NEW Targets for treatment:

  • If ASCVD 10-year-risk is <10%, then target BP <140/90
  • If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
    • Established CVD
    • DIABETES
    • CKD
    • AGE>65  and “healthy” (diastolic, not as important)
  • Age >65 and “frail”: use clinical judgment.

 

Conceptual conclusion:

  • The lower BP, the better;
    • as long as…
      • treatment-induced hypotension
      • side effects
      • drug interactions
    • are avoided.

 

Gerti Tashko, M.D.