🎧 PodCast: Dr RR Baliga's Internal Medicine Podcasts for Physicians: MUST KNOW FACTs about ACC/AHA Guidelines on High BP in Adults

December 4, 2021 | R.R. Baliga, MD

🎧 ACC/AHA Guidelines on High BP in Adults--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)


 

 

It is estimated that the prevalence of hypertension is going to continue to increase with the aging population. Worldwide it is estimated that 874 million individuals have a systolic blood pressure ≥140 mm Hg and 79% of men and 85% of women >75 years old have hypertension.

 

It is important to control BP to prevent STROKES, HEART FAILURE & KIDNEY FAILURE--i.e. to prevent damage to the vital organs viz. brain, heart & kidneys

 

 

New BP Classification

This guidelines, keeping in mind that blood pressure as a risk factor is a continuum, has reclassified BP into 4 categories

° Normal                                          <120 mm Hg

° Elevated                                        120-129/<80 mm Hg

° Stage 1 Hypertension                   130-139/80-89 mm Hg

° Stage 2 Hypertension                   ≥140/≥90 mm Hg

 

Out-of-office BP measurements (particularly, home BP measurements) are recommended in this guideline, both to diagnose and titrate anti-hypertensive medications

According to this definition, about 46% of U.S. adults have hypertension, as compared with about 32% under the previous definition

 

Therapy

 

  1. Non-Pharmacologic Interventions: have been shown to reduce SBP by 5 to 10 mm Hg in various clinical trials and therefore these guidelines include:

    • Weight Loss for obese and over-weight individuals—It is estimated that BP decreases by 1 mm Hg for every kg (2.2 lbs.) of weight loss.
    • DASH (Dietary Approaches to Stop Hypertension) diet—adoption of this diet has resulted in an 11-mm Hg decrease in SBP.
    • Sodium restriction
    • Potassium Supplementation
    • Increased Physical Activity
    • Restriction of alcohol consumption--no more than 1 standard alcohol drink(s) per day in women and no more than 2 per day in men

 

  • Pharmacologic Interventions: recommended

    • When BP is ≥130/80 mm Hg in those at high risk† for cardiovascular disease
    • When BP is ≥140/90 mm Hg in those without risk or low risk† for cardiovascular disease

 

†These guidelines recommend using an ASCVD risk score of 10% (the estimated 10-year risk of myocardial infarction, cerebrovascular accident, or death due to coronary heart disease).

 

  1. First-line agents recommended, in this guideline, include thiazide diuretics, calcium channel blockers, ACE-inhibitors, or ARBs.
  2. These guidelines continue JNC7 recommendations for the use of 2 first-line agents of different classes in patients with stage-2 hypertension and an average BP of >20/10mmHg above their BP target
  3. Potential Adverse Events:
    • In the ACCORD trial, there was an increase in serious adverse events attributable to BP lowering medications (3.3% vs. 1.27%; p < .001).
    • In the SPRINT Trial, although there was no overall increase in adverse events, there were increases in hypotension (2.4% vs. 1.4%; p < .001) and syncope (2.3%vs 1.7%; p = .05)

 

References:

2017 ACC/AHA/.  Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary:  Journal of the American College of Cardiology May 2018, 71 (19) 2199-2269

American College of Cardiology High BP Management Hub

NEJM Perspective on these Guidelines by Drs George Bakris & Matthew Sorrentino

Managing Hypertension in the Elderly

Nearly half of U.S. adults have high blood pressure under new guidelines

Internal Medicine - Mastermedfacts

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