New Hypertension Guidelines from The American Heart Association
Nov 15, 2017
Highlights A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
For years, hypertension was classified as a blood pressure (BP) reading of 140/90 mm Hg or higher, but the updated guideline classifies hypertension as a BP reading of 130/80 mm Hg or higher. The updated guideline also provides new treatment recommendations, which include lifestyle changes as well as BP-lowering medications.
Change in classification of BP:
Based on risk and clinical trial experience, this guideline recommends a new approach to classification of blood pressure (BP) in adults. Compared to the systolic BP (SBP) and diastolic BP (DBP) levels used to designate the presence of hypertension in recent previous guidelines (average SBP ≥140 mm Hg or average DBP ≥90 mm Hg), this guideline recommends use of an average SBP ≥130 mm Hg or an average DBP ≥80 mm Hg.
More hypertension patients:
Because the new definition of hypertension is lower (130/80 mm Hg), more people will be classified as having hypertension. However, most of these new patients can prevent hypertension-related health problems through lifestyle changes alone.
Focus on accurate measurements:
To ensure accurate measurements, make sure the instrument you are using is properly calibrated. The updated guideline also stresses the basic processes for accurately measuring BP, including some simple yet critical actions before and during measurements.
Focus on self-monitoring:
Office BPs are often higher than ambulatory or home BPs, so the updated guideline emphasizes having patients monitor their own BP for hypertension diagnosis, treatment, and management.
Non-pharmacological treatment recommendations:
The updated guideline presents new treatment recommendations, which include lifestyle changes as well as BP-lowering medications. These lifestyle changes can reduce systolic BP by approximately 4 to 11 mm Hg for patients with hypertension, with the biggest impacts being changes to diet and exercise.
- In addition to promoting the DASH diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products, the updated guideline recommends reducing sodium intake and increasing potassium intake to reduce BP. However, some patients may be harmed by excess potassium, such as those with kidney disease or who take certain medicines.
- Each patient’s ideal body weight is the best goal, but as a rule, expect about a 1 mm Hg BP reduction for every 1 kg reduction in body weight.
- Recommendations for physical activity include 90 to 150 minutes of aerobic and/or dynamic resistance exercise per week and/or 3 sessions per week of isometric resistance exercises.
- For patients who drink alcohol, aim for reducing their intake to 2 or fewer drinks daily for men and no more than 1 drink daily for women.
Decisions to manage hypertension using BP-lowering medication, in addition to nonpharmacological interventions, should be based on level of BP together with the patient’s underlying risk for cardiovascular disease such as heart attack or stroke. Recommendations are provided for BP medication treatment thresholds in the context of underlying risk of cardiovascular disease, BP targets during therapy, and follow-up after initiation of therapy.
For BP measurement and management of hypertension, please Contact Us at the Health Services.