Hypertension

Wilbert S. Aronow, MD, on the New Hypertension Guidelines

Nearly half of US adults now meet the criteria for hypertension, according to new guidelines for the detection, prevention, management, and treatment of hypertension issued by the American Heart Association (AHA) and the American College of Cardiology (ACC).1

The new definition of hypertension stands in contrast with the previous one, which identified 32% of US adults (1 in 3) as having hypertension. Now, under the AHA/ACC’s new guidelines, the proportion of US adults with hypertension has risen sharply to 46% (nearly 1 in 2). As a result, more adults in the United States have a higher risk for cardiovascular disease (CVD) than before.

Recently, Consultant360 spoke with Wilbert S. Aronow, MD, FAHA, FACC, professor of medicine and director of cardiology research at Westchester Medical Center and New York Medical College in Valhalla, New York, about the AHA/ACC’s new guidelines and what they mean for the treatment of hypertension going forward. Dr. Aronow presented “Initiation of Antihypertensive Therapy”2 at the AHA Scientific Sessions 2017 and is a member of the 21-person committee of experts who composed the new guidelines.

Consultant360: What specifically do these guidelines address, and who will be affected by them?

Wilbert Aronow: The new AHA/ACC hypertension guidelines, which have been endorsed by 11 professional societies, provide new criteria for diagnosing hypertension. These guidelines diagnose a normal blood pressure (BP) if it is below 120/80 mm Hg, regardless of age. Elevated BP includes a systolic BP of 120 to 129 with a diastolic BP of less than 80, and should be treated with nonpharmacologic lifestyle measures.

Hypertension is now diagnosed with a systolic BP of 130 and higher, or with a diastolic BP of 80 and higher. Stage 1 hypertension is diagnosed with a systolic BP of 130 to 139, or a diastolic BP of 80 to 89. Stage 2 hypertension is diagnosed with a systolic BP of 140 and higher, or a diastolic BP of 90 and higher.

C360: What is different about the new guidelines vs the previous ones?

WA: Unlike the previous guidelines, the new guidelines now include the following recommendations:

  • The absolute cardiovascular (CV) risk reduction attributable to the lowering of BP is greater at higher absolute levels of CVD risk.
  • Predicted CV risk in conjunction with BP should be used to guide antihypertensive drug treatment.
  • The use of nonpharmacologic therapy plus BP-lowering drugs is recommended for secondary prevention of recurrent CVD events in adults with:
    • Clinical CVD.
    • An average systolic BP of 130 and higher, or an average diastolic BP of 80 and higher.
  • The use of nonpharmacologic therapy plus BP-lowering drugs is recommended for primary prevention of CVD in adults with:
    • An estimated 10-year risk of atherosclerotic CVD of at least 10% [Note: All patients age 65 years or older have an estimated 10-year risk of atherosclerotic CVD of 10% and higher, even if they have no additional risk factors for the disease].
    • An average systolic BP of 130 and higher, or an average diastolic BP of 80 and higher.
  • The use of nonpharmacologic therapy plus BP-lowering drugs is recommended for primary prevention of CVD in adults with:
    • No history of CVD.
    • An estimated 10-year risk of atherosclerotic CVD of less than 10%.
    • An average systolic BP of 140 and higher, or an average diastolic BP of 90 and higher.
  • White coat hypertension must be excluded before starting antihypertensive drug therapy in patients with hypertension with a low risk for atherosclerotic CVD.
  • Adults who meet the following criteria should be treated initially with nonpharmacologic therapy plus 2 antihypertensive drugs from different classes:
    • A systolic BP of 140 and higher, or a diastolic BP of 90 and higher.
    • An increased risk for CVD.
  • Adults with a BP that is more than 20/10 mm Hg above their BP target should be treated initially with nonpharmacologic therapy plus 2 antihypertensive first-line drugs from different classes.

C360: How will these guidelines change how practitioners manage patients?

WA: Practitioners will now have to diagnose more patients with hypertension, especially if they are elderly, and will need to treat them in accordance with a lower BP goal.

—Christina Vogt

Reference:

1. Vogt C. New AHA/ACC guidelines lower high BP threshold. Consultant360. November 14, 2017. https://www.consultant360.com/exclusives/new-ahaacc-guidelines-lower-high-bp-threshold.

2. Aronow WS. Initiation of antihypertensive therapy. Presented at: American Heart Association (AHA) Scientific Sessions 2017; November 11-15, 2017; Anaheim, CA. http://www.abstractsonline.com/pp8/ - !/4412/presentation/55060.