Blood pressure guidelines for 2017

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    Blood pressure guidelines for 2017


    In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The committee reviewed literature and commissioned systematic reviews and meta-analyses on out-of-office BP monitoring, the optimal target for BP lowering, the comparative benefits and harms of different classes of antihypertensive agents, and the comparative benefits and harms of initiating therapy with a single antihypertensive agent or a combination of 2 agents. This article summarizes key recommendations in the following areas: BP classification, BP measurement, screening for secondary hypertension, nonpharmacologic therapy, BP thresholds and cardiac risk estimation to guide drug treatment, treatment goals (general and for patients with diabetes mellitus, chronic kidney disease, and advanced age), choice of initial drug therapy, resistant hypertension, and strategies to improve hypertension control. Hypertension is the leading cause of death and disability-adjusted life-years worldwide (1, 2). In the United States, hypertension accounts for more cardiovascular disease (CVD) deaths than any other modifiable risk factor and is second only to cigarette smoking as a preventable cause of death for any reason (3). The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults provides an evidence-based approach to reduction of CVD risk through lowering of blood pressure (BP) (4). In 1977, the National Heart, Lung, and Blood Institute (NHLBI) initiated a series of hypertension guidelines, culminating in the 2003 publication of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) (5). Background The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline provides updated recommendations for antihypertensive medication initiation and intensification. Objectives Determine the risk for cardiovascular disease (CVD) events among adults recommended and not recommended antihypertensive medication initiation or intensification by the 2017 ACC/AHA BP guideline. Methods The authors analyzed data for black and white REGARDS (REasons for Geographic And Racial Differences in Stroke) study participants (age ≥45 years). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at baseline (2003 to 2007) and averaged. Participants not taking (n = 14,039) and taking (n = 15,179) antihypertensive medication were categorized according to their recommendations for antihypertensive medication initiation and intensification by the 2017 ACC/AHA guideline. Overall, 4,094 CVD events (stroke, coronary heart disease, and heart failure) occurred by December 31, 2014. Results Among participants not taking antihypertensive medication, 34.4% were recommended pharmacological antihypertensive treatment initiation.

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    Hypertension Clinical Guidelines. Previous guidelines identified high blood pressure as ≥ 140/90 mm Hg. This guideline now defines high blood pressure to be anyone with a systolic blood pressure SBP ≥ 130 mm Hg or diastolic blood pressure DBP ≥ 80 mm Hg. The ACC/AHA 2017 recommendations -- in color and by the numbers. These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include 1 the replacement of the term “prehypertension” with the term “elevated blood pressure,” 2 new normative pediatric blood pressure BP tables based on.

    And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. The 2017 guideline is an update of “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure” (JNC 7), published in 2003. This guideline is comprehensive and incorporates new information from studies regarding blood pressure (BP)-related risk of cardiovascular disease (CVD), ambulatory BP monitoring (ABPM), home BP monitoring (HBPM), BP thresholds to initiate antihypertensive drug treatment, BP goals of treatment, strategies to improve hypertension treatment and control and various other important issues. The American College of Cardiology (ACC)—along with collaborative societies—create Clinical Practice Guidelines, which become ACC policy at the time of publication. All Clinical Practice Guidelines undergo rigorous peer review that is independent of the Editors/editorial processes of the Editors receive no compensation from the publication of the guidelines nor other ACC clinical/policy documents.

    Blood pressure guidelines for 2017

    ACC/AHA Blood Pressure Treatment Guideline. - JACC, A Visual Guide to the New Blood Pressure Guidelines Medpage.

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  6. The new guidelines stem from the 2017 results of the Systolic Blood Pressure Intervention Trial SPRINT, which studied more than 9,000 adults ages 50 and older who had systolic blood pressure the top number in a reading of 130 mm Hg or higher and at

    • Reading the new blood pressure guidelines - Harvard Health.
    • Clinical Practice Guideline for Screening and Management..
    • High Blood Pressure Guidelines 2017 - CardioSmart.

    The following are key points to remember from the 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood. High blood pressure should be treated at 130/80 rather than 140/90, according to new guidelines from the American Heart Association and the American College of Cardiology. Guidelines for Management of High Blood Pressure in Adults. In 2014, panel members of the Eighth Joint National Committee published the results of their evidence review and deliberations about the prevention, detection, evaluation, and treatment of high blood pressure.

     
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