2018 ACC/AHA new hypertension guidelines review

By: Gabrielle Flavoni, PharmD Candidate c/o 2018

–

This past November, the ACC/AHA released a new definition for the word “hypertension” that has been updated for the first time since 2003. Under these new guidelines, more than half of the U.S. population will now be categorized as having high blood pressure. Presented at the AHA’s 2017 Scientific Sessions, the new controversial guidelines now lower the threshold for blood pressure to 130/80 mm Hg instead of the previous 140/90 mm Hg.¹

The goal of having a lower threshold is to identify high blood pressure earlier in order to prevent complications. Based on the earlier guidelines, a significant amount of adults who had consistent elevated blood pressure went untreated, and progressed on to develop poor cardiac outcomes. By beginning treatment earlier, patients are able to prevent blood vessel damage and improve future outcomes.² This is especially important in the younger populations, who can be properly educated and keep themselves healthier before medical intervention becomes necessary.

The big question becomes, where does this leave us now? The new guidelines have different numerical definitions for each level of hypertension, and patients need to be educated as to where their numbers place them. Health care providers will continue to play a pivotal role in the education of the general public, and not just in terms of where they fall on the hypertension spectrum. The priority should also lie in demonstrating to patients the proper way to measure blood pressure at home, as well as lifestyle modifications that can help bring them closer to their blood pressure goal.²

That being said, having elevated blood pressure does not automatically place patients into a category requiring medication. It is simply seen as a warning sign for lifestyle modification to prevent the elevation to progress. In fact, the new comprehensive guidelines recommend that patients in the “Stage I” classification (SBP 130 – 139 mmHg or DBP 80 – 89 mmHg) to only be medicated if they have already had a cardiovascular event, such as a heart attack or a stroke, or if they are at a high risk for a cardiovascular event based on other health conditions such as diabetes or chronic kidney disease.^1,2

The new guidelines also highlight the idea that many people with hypertension will require more than one medication to control their blood pressure. One of the biggest hardships with controlling disease states lies in medication adherence. Therefore, maximizing “combination pills” that contain more than one medication in a single pill can be a primary tool in improving health care outcomes. Identifying patient-specific factors is also important in maximizing treatment. Authors suggest that identifying the socioeconomic status, race, psychological stresses, and other risk factors is vital in the development of a patient’s care plan. ^1,2

For now, providers should focus on education. When our patients can fully understand their health status, they have a better ability to help themselves while preventing further damage. This includes teaching those in the community how to properly measure their own blood pressure at home, sharing tips on how to keep a record of their readings for their providers, and educating them on how to become the healthiest versions of themselves.

 

SOURCES:

1. New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Accessed January 21, 2018.
2. New Hypertension Guidelines Lower Starting Point for High Blood Pressure. Pharmacy Times. http://www.pharmacytimes.com/news/new-hypertension-guidelines-lower-starting-point-for-high-blood-pressure. Accessed January 21, 2018.
3. High Blood Pressure Guidelines Hub. High Blood Pressure Guidelines Hub | JACC: Journal of the American College of Cardiology. http://www.onlinejacc.org/guidelines/highbloodpressure. Accessed January 21, 2018.