John Murphy, MDLinx | November 15, 2017
Hypertension is now defined as a systolic blood pressure (SBP) of 130 mm Hg and higher or a diastolic blood pressure (DBP) of 80 mm Hg and higher, according to a new blood pressure guideline developed by the American College of Cardiology (ACC), the American Heart Association (AHA), and nine other professional organizations.
The new guideline — presented November 13 at the AHA’s 2017 Scientific Sessions conference in Anaheim, CA, and simultaneously published in both Hypertension and the Journal of the American College of Cardiology — is the first comprehensive revision of hypertension classifications since 2003.
The new guideline defines blood pressure categories as:
An average of two or more readings should be obtained on two or more occasions to determine blood pressure measurements, the guideline recommends. The category of prehypertension, which was defined as a SBP between 120-139 mm Hg or a DBP between 80-89 mm Hg, has been eliminated.
Lowering the threshold of hypertension to 130/80 mm Hg from the previous definition of 140/90 mm Hg means that nearly half (46%) of the US adult population now has high blood pressure.
However, “The new definition results in only a small increase in the percentage of US adults for whom antihypertensive medication is recommended in conjunction with lifestyle modification,” wrote authors led by Paul K. Whelton, MB, MD, MSc, the Show Chwan professor of global public health at Tulane University School of Public Health and Tropical Medicine and School of Medicine in New Orleans, LA.
The new guideline reflects a stronger emphasis on the prevention, awareness, treatment, and control of high blood pressure, the authors noted.
“Details aside, the guideline sends a clear directive: We must more aggressively help people lower their blood pressure to healthier levels,” said AHA president John Warner, MD, MBA. “Early intervention can help prevent problems, slow damage that has already started, and lower the risk for a cardiac event or stroke.”
Nonpharmacologic interventions may be enough to prevent hypertension and meet blood pressure goals in many patients, the authors noted. The guideline recommends six such interventions:
For confirmation and management of hypertension, the guideline also recommends out-of-office blood pressure monitoring using validated home blood pressure monitoring devices along with appropriate training.
Out-of-office measurement can reveal white-coat hypertension (higher blood pressure in the office versus out-of-office) as well as masked hypertension (normal blood pressure in the office but uncontrolled blood pressure in out-of-office settings).
“People with white-coat hypertension do not seem to have the same elevation in risk as someone with true sustained high blood pressure,” Dr. Whelton said. “Masked hypertension is more sinister and very important to recognize because these people seem to have a similar risk as those with sustained high blood pressure.”
Lastly, the authors acknowledged, “This document is, as its name implies, a guide. In managing patients, the responsible clinician’s judgment remains paramount.”