New definitions:
- treatment-induced hypotension
- side effects
- drug interactions
Gerti Tashko, M.D.
- Established CVD
- DIABETES
- CKD
- AGE>65 and “healthy” (diastolic, not as important)
Conceptual conclusion:
- The lower BP, the better;
- as long as…
- treatment-induced hypotension
- side effects
- drug interactions
- are avoided.
- as long as…
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.
- as long as…
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.
- as long as…
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.
- as long as…
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.
- as long as…
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.
- as long as…
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.
- as long as…
Gerti Tashko, M.D.