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HelixTalk Episode #71 - Holy Hypertension Guidelines - Holiday Edition!

Date posted: December 19, 2017, 6:00 am

In this episode, we review the important changes in 2017 ACC/AHA guidelines for hypertension management in adults

 

Key Concepts

  1. The 2017 ACC/AHA guidelines are the true comprehensive update of JNC7, addressing BP definitions, hypertension diagnosis, BP goals, non-pharmacologic and pharmacologic treatment options, and proper follow-up and approach to overall hypertension care.
  2. The term "pre-hypertension" has been replaced with "elevated BP".  The definitions and staging of hypertension have also been updated.
  3. An emphasis has been placed on the proper measurement of blood pressure, including ambulatory and home-based BP monitoring in order to diagnose hypertension, masked hypertension, and whitecoat hypertension.
  4. The blood pressure goal for most patients is less than 130/80 mmHg.  This goal includes diabetics and elderly (>65 years old), which is now different than both the American Diabetes Association guidelines and the JAMA 2014 (JNC 8) guidelines.
  5. Non-pharmacologic therapy for hypertension includes sodium restriction, favoring foods rich in potassium, physical activity, and weigh loss.  Details of each of these interventions at a very granular level are available within the guidelines.
  6. Drug therapy for hypertension should be initiated in patients with a blood pressure exceeding 130/80 mmHg and either clinical ASCVD or a 10-year ASCVD risk exceeding 10%.  For low-risk patients without ASCVD and have a 10-year risk below 10%, drug therapy should be initiated if the blood pressure exceeds 140.90 mmHg.
  7. For patients with stage II hypertension (BP above 140/90 mmHg), initiate a two-drug regimen as opposed to a single drug regimen.
  8. These guidelines recommend the same four first-line drug therapy options for hypertension, and like JNC7, outline a number of compelling indications in which you would select a specific drug therapy for hypertension (i.e., use of beta blockers in patients with systolic heart failure).
  9. For pregnant patients with hypertension, the 2017 guidelines equally prefer methyldopa, nifedipine XL, or labetalol.
  10. Follow-up and monitoring intervals are clearly outlined in the new guidelines.

References

  1. Guidelines Made Simple. 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Available at: http://www.acc.org/education-and-meetings/image-and-slide-gallery/media-detail?id=BDA0F36F3160426FAB2E784B82E2629A.
  2. 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. J Am Coll Cardiol. 2017 Nov 7. pii: S0735-1097(17)41519-1.  Available at http://www.acc.org/guidelines/hubs/high-blood-pressure.
  3. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20.  Available at https://jamanetwork.com/journals/jama/fullarticle/1791497.