New Guidelines Revise Definition of Hypertension
November 13, 2017—The American Heart Association (AHA) and American College of Cardiology (ACC) announced the publication of the first comprehensive new guidelines since 2003 on the detection, prevention, management, and treatment of high blood pressure. The guidelines were published by Paul K. Whelton, MD, et al online ahead of print in the AHA's journal, Hypertension, and in Journal of the American College of Cardiology. The guidelines were presented at the AHA 2017 scientific sessions held November 11–15 in Anaheim, California.
Under the new guidelines, high blood pressure should be treated earlier with lifestyle changes and, in some patients, with medication—at 130/80 mm Hg rather than at 140/90 mm Hg under previous guidelines. These guidelines are designed to help people address this potentially deadly condition earlier. Additionally, the new guidelines stress the importance of using proper technique to measure blood pressure. Blood pressure levels should be based on an average of two to three readings on at least two different occasions, the authors stated.
According to AHA/ACC, 32% of adults in the United States had high blood pressure under the previous definition, and the new guidelines will result in 46% of the United States adult population having hypertension. However, the authors advised that there will only be a small increase in the number of adults who will require antihypertensive medication.
Blood pressure categories in the new guideline are:
- Normal: < 120/80 mm Hg
- Elevated: systolic of 120–129 mm Hg and diastolic < 80 mm Hg
- Stage 1: systolic of 130–139 mm Hg or diastolic of 80–89 mm Hg
- Stage 2: systolic ≥ 140 mm Hg or diastolic ≥ 90 mm Hg
- Hypertensive crisis: systolic >180 mm Hg and/or diastolic > 120 mm Hg, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage
- The new guidelines eliminate the category of prehypertension, which was used for blood pressures with a systolic reading between 120–139 mm Hg or a diastolic reading between 80–89 mm Hg; patients with those readings will now be categorized as having either elevated (systolic 120–129 mm Hg and diastolic < 80 mm Hg) or stage I hypertension (systolic 130–139 mm Hg or diastolic 80–89 mm Hg)
- Previous guidelines classified 140/90 mm Hg as stage 1 hypertension, but under the new guidelines, this level is classified as stage 2 hypertension
Other changes in the new guideline include:
- Only prescribing medication for stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease, or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol)
- Recognizing that many people will need two or more types of medications to control their blood pressure and that people may take their pills more consistently if multiple medications are combined into a single pill
- Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care