An overview of new hypertension guidelines

New definitions:

treatment-induced hypotension
side effects
drug interactions

are avoided.

Gerti Tashko, M.D.

Established CVD
DIABETES
CKD
AGE>65 and “healthy” (diastolic, not as important)

Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

11 health professional organizations participated.
Panel was composed of 21 scientists and health experts.
More than 900 publications were used.
In 2013, the NHLBI asked the AHA and ACC to proceed with development of new blood pressure guidelines.

New definitions (best to check BP at home):

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

2003: JNC 7 – the last major credible guidelines
2014: JNC 8 – debunked, particularly for setting a target BP <150/90 mmHg for all patients > 60 of age.
2017: The new ACC/AHA guidelines are considered to be the true continuation of JNC 7

Facts about new guidelines:

11 health professional organizations participated.
Panel was composed of 21 scientists and health experts.
More than 900 publications were used.
In 2013, the NHLBI asked the AHA and ACC to proceed with development of new blood pressure guidelines.

New definitions (best to check BP at home):

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

Established CVD
DIABETES
CKD
AGE>65 and “healthy”

GT

Also see:

2017 ADA position statement: hypertension in diabetes

New HTN treatment: Baroreflex activation therapy (BAT)

Review of resistant hypertension

Important indicators of masked hypertension

White coat syndrome in refractory hypertension

Systolic Blood Pressure in Older Adults >75

Comprehensive review of blood pressure in type 2 diabetes

Systolic Blood Pressure and Mortality in Individuals >80

Hypertension

Guidelines

November 2017

Timeline:

2003: JNC 7 – the last major credible guidelines
2014: JNC 8 – debunked, particularly for setting a target BP <150/90 mmHg for all patients > 60 of age.
2017: The new ACC/AHA guidelines are considered to be the true continuation of JNC 7

Facts about new guidelines:

11 health professional organizations participated.
Panel was composed of 21 scientists and health experts.
More than 900 publications were used.
In 2013, the NHLBI asked the AHA and ACC to proceed with development of new blood pressure guidelines.

New definitions (best to check BP at home):

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

New targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy”

GT

Also see:

2017 ADA position statement: hypertension in diabetes

New HTN treatment: Baroreflex activation therapy (BAT)

Review of resistant hypertension

Important indicators of masked hypertension

White coat syndrome in refractory hypertension

Systolic Blood Pressure in Older Adults >75

Comprehensive review of blood pressure in type 2 diabetes

Systolic Blood Pressure and Mortality in Individuals >80

Hypertension

Guidelines

November 2017

Timeline:

2003: JNC 7 – the last major credible guidelines
2014: JNC 8 – debunked, particularly for setting a target BP <150/90 mmHg for all patients > 60 of age.
2017: The new ACC/AHA guidelines are considered to be the true continuation of JNC 7

Facts about new guidelines:

11 health professional organizations participated.
Panel was composed of 21 scientists and health experts.
More than 900 publications were used.
In 2013, the NHLBI asked the AHA and ACC to proceed with development of new blood pressure guidelines.

New definitions (best to check BP at home):

Normal BP: <120/80 mmHg
Elevated BP “Pre HTN”: 120-130/<80
Stage 1 HTN: 130-140/80-90
Stage 2 HTN: >140/90

Treatment, similar principal to 2013 ACC/AHA Lipid guidelines.

All about risk factors (global risk)
Simplified by the 10% ASCVD cutoff risk in 10 years
Calculate the 10-year-risk here (ASCVD estimator)

NEW Targets for treatment:

If ASCVD 10-year-risk is <10%, then target BP <140/90
If ASCVD 10-year-risk is ≥10%, then target BP <130/80 (the following are considered to be ≥10%)
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Age >65 and “frail”: use clinical judgment.

Conceptual conclusion:

The lower BP, the better;
- as long as…
  - treatment-induced hypotension
  - side effects
  - drug interactions
- are avoided.

Gerti Tashko, M.D.