AHA/ACC Release Revised, More Aggressive Blood Pressure Targets

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New hypertension guidelines now categorize nearly half the US adult population as hypertensive.
New hypertension guidelines now categorize nearly half the US adult population as hypertensive.

Updated definitions for high blood pressure now classify nearly half of US adults as hypertensive, many of whom are not receiving appropriate therapy, according to new guidelines from the American College of Cardiology/American Heart Association (ACC/AHA), published in Hypertension and simultaneously presented at the 2017 American Heart Association Scientific Sessions held from November 11-15 in Anaheim, California.1,2

A prevention subcommittee organized by the ACC/AHA Task Force developed the recent guidelines, focusing the majority of their efforts on providing education on cardiovascular disease prevention. The subcommittee gathered recent data from randomized controlled trials, patient registries, case series, systematic reviews, and nonrandomized descriptive and comparative studies to form the guidelines.

In the report, hypertension is now defined as a blood pressure of ≥130/80 mm Hg. Previously published guidelines in 2003 categorized hypertension diagnosis as a blood pressure of ≥140/90 mm Hg.3 These new guidelines essentially increase the proportion of adults in the United States who have hypertension.

In addition to pharmacologic intervention for reducing blood pressure, the 2017 ACC/AHA guidelines recommend lifestyle modifications, especially for the 9.4% of adults with hypertension who are not appropriate candidates for antihypertensive medications.4 These alternative management strategies include weight loss, smoking cessation, moderation of alcohol consumption, and increased physical activity.

A study in the Journal of the American College Cardiology found that 45.6% of US adults have hypertension under the new ACC/AHA guidelines.4 Using the expanded definition for hypertension, the researchers theorized that a greater number of individuals will be diagnosed with high blood pressure and will subsequently be prescribed antihypertensive medications.

The investigators of the study suggested that patients are not meeting the new blood pressure target and “a substantial [cardiovascular disease] risk reduction benefit should occur with more intensive antihypertensive medication treatment.”

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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online November 13, 2017]. Hypertension. doi:10.1161/HYP.0000000000000065
  2. Whelton PK, Carey RM, Aronow WS, et al. 2017 [published online November 3, 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.11.005
  3. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2571.
  4. Muntner P, Carey RM, Gidding S, et al. Potential U.S. population impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline [published online November 13, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.032582
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