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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
- 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.
- The term "pre-hypertension" has been replaced with "elevated BP". The definitions and staging of hypertension have also been updated.
- 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.
- 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.
- 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.
- 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.
- For patients with stage II hypertension (BP above 140/90 mmHg), initiate a two-drug regimen as opposed to a single drug regimen.
- 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).
- For pregnant patients with hypertension, the 2017 guidelines equally prefer methyldopa, nifedipine XL, or labetalol.
- Follow-up and monitoring intervals are clearly outlined in the new guidelines.
- 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.
- 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.
- 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.