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AHA/ACC Issues New Hypertension Guidelines


AHA/ACC Issues New Hypertension Guidelines

 In 2014, the ACC and AHA, in partnership with 9 other professional societies (representing the major professional organizations who agreed to provide representatives), appointed a writing committee to develop a new BP CPG. The writing committee’s recently published guideline was developed over a 3-year period by a multidisciplinary team.

 

Although several BP CPGs have been published since 2003, the 2017 guideline is the most comprehensive US adult BP CPG since the JNC 7 report and have been developed by American College of Cardiology (ACC) and American Heart Association (AHA).

Major recommendations

  1. Diagnosis

    • Blood pressure (BP) should be categorized as normal (<120/80 mm Hg), elevated (120-129/<80 mm Hg), stage 1 hypertension (130-139/80-89 mm Hg), or stage 2 hypertension (≥140/90 mm Hg) (strong recommendation; moderate-quality evidence).

    • Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication in conjunction with telehealth counseling or clinical interventions (strong recommendation; high-quality evidence).

  2. Initiating therapy

    • Many nonpharmacologic interventions that are effective in lowering BP are recommended for people with elevated BP or hypertension (strong recommendation; high-quality evidence).

    • Blood pressure–lowering medication is recommended for patients with clinical CVD or an estimated 10-year atherosclerotic CVD (ASCVD) risk of 10% or higher who have a systolic BP (SBP) of 130 mm Hg or higher or a diastolic BP (DBP) of 80 mm Hg or higher (strong recommendation; high-quality evidence [for SBP] and expert opinion [for DBP]).

    • For patients with no history of CVD and an ASCVD risk of less than 10%, BP-lowering medication is recommended for patients who have an SBP of 140 mm Hg or higher or a DBP of 90 mm Hg or higher (strong recommendation; low-quality evidence).

  3. Management

    • In patients with CVD or ASCVD event risk of 10% or higher, a BP target of less than 130/80 mm Hg is recommended (strong recommendation; moderate-quality evidence [for SBP] and expert opinion [for DBP]). A BP target of less than 130/80 mm Hg may also be reasonable in low-risk patients (weak recommendation; moderate-quality evidence [for SBP] and expert opinion [for DBP]).

    • In patients warranting pharmacotherapy, thiazide diuretics, calcium channel blockers (CCBs), and angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are recommended as first-line agents (strong recommendation; high-quality evidence).

    • Patients with stage 2 hypertension and an average BP of more than 20/10 mm Hg above their BP target should begin therapy with 2 first-line agents of different classes (strong recommendation; expert opinion).

To Read the full guideline click on the following link: doi:10.1001/jama.2017.18209 


Source: self

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  1. Stringent criteria and stricter control levels may evoke an unease , as noticed by initial comments of spontaneity on the revised guidelines. Going by the facts that many are unaware that they have Hypertension and also the significant number of hypertensive who are plainly non compliant or have an utterly erratic control , the newer guidelines can help create enhanced awareness and better compliance to lifestyle measures or /and drugs. Dr ME Yeolekar Mumbai.