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.


    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.

    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.

    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.

    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

    Untitled.png

    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.

    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

    Untitled.png

    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.

    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.