The American College of Cardiology and American Heart Association’s recent update of the Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults includes new, innovative findings from recent clinical trial data on hypertension diagnosis, prevention, and management.
George Bakris, MD, a collaborating author of a perspective article published in the New England Journal of Medicine, discussed his opinions on the new update with The Cardiology Advisor and how he believes these guidelines will affect clinical practice and patient care.
The Cardiology Advisor: What do you think of the new classifications of hypertension and prehypertension? How does this affect patients you treat?
Dr Bakris: The new classification system integrates the concept of the 10-year risk [for] cardiovascular risk >10%, and so for those reasons I like it. As a writer of the Seventh Report of the Joint National Committee guidelines, I can tell you the term “prehypertension” was derived from focus groups asking patients which term would resonate with them and would make the physician do something about the patient’s blood pressure. The overwhelming response of the 5 terms we provided was “prehypertension.” It is not a scientific term. As a nephrologist and hypertension specialist, it does not really change what I have been doing as I have been working to get blood pressures to 130, including in older people who can tolerate this level.
The Cardiology Advisor: Are you concerned that patients who were not recommended for pharmacologic therapy will now be recommended? Additionally, do you think these guidelines will contribute to the overtreatment of patients?
Dr Bakris: Yes, I am concerned about this as the intent was to focus more on lifestyle changes and not on drugs. The guidelines are just that — guidelines. The policy and administrative types need to change the requirements for time spent with the patient so physicians can be physicians and educate patients about their risk factors and how to manage them. They should not take the approach of current and previous administrations that punish people for not achieving a recommended blood pressure level as if it is a holy grail. Thus, these guidelines will clearly lead to overtreatment.
The Cardiology Advisor: How might a more personalized, precision-medicine based approach help shape future hypertension guidelines?
Dr Bakris: A true personalized approach sounds great, but short of certain cancer treatments for specific tumors, hypertension is not ready for this. The genetics are not worked out to a point where each patient can be told about a specific regimen or diet that is right for them.
Bakris G, Sorrentino M. Redefining hypertension — assessing the new blood-pressure guidelines. N Engl J Med. 2018;378:497-499.